Comparative efficacy and survival of biologics in inflammatory bowel disease in different lines of therapy: the clinician’s view of the problem

AIM: to analyze publications and assess the current state of the issue on the comparative efficacy and survival of different classes and different lines of biological therapy for inflammatory bowel diseases (IBD)
MATERIALS AND METHODS: the search for publications was done in the PUBMED, MEDLINE, EMBASE databases and Cochrane Library from 2013 to 2024 using key words and phrases “Inflammatory bowel disease”, “ulcerative colitis”, “Crohn’s disease”, “biologics survival/persistence”, “comparative efficacy of biologics in different therapy lines”, “biologics”, “immunogenicity”. 
RESULTS: loss of response over time is observed for all biologic agents. The choice of the first biologic agent may affect the efficacy of subsequent lines of therapy. TNF inhibitors are most often prescribed in the first line of therapy, but their survival in IBD is lower compared to biologic agents of other classes: half of the patients loses response after 1–2 years. Switching within one class of biologic agents (TNF inhibitors) reduces the efficacy of the second line of therapy. The survival of INF and ADA is comparable in CD, but in UC, the survival of INF is higher than that of ADA and GOL. Data on the efficacy and survival of VEDO in the 1st and 2nd lines of therapy are contradictory. Most studies assessing the survival and efficacy of biologic agents do not exceed one year, that is insufficient to predict the long-term outcome. There is data on high long-term efficacy and survival of UST without significant loss of response for 4–5 years in bio naive IBD patients and in bio failures. UST has a higher survival rate than VEDO in the second line of therapy in case of loss of response to INF. In case of loss of response to biologics, it is advisable to evaluate the level of antibodies and drug concentration in the blood.
CONCLUSION: studies on the survival and long-term efficacy of biologic therapy are very limited and contradictory. More direct comparative studies of different classes of biologics in the first and subsequent lines of therapy are needed. In real practice, it is necessary to consider the existing data on the survival of biologics when choosing therapy.

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