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Prof Leong
The decision about which biologic to choose for patients with Crohn’s disease used to be based largely on their preference for subcut or IV administration.
And given the biologics and their biosimilars have similar rates of clinical remission, safety has become one of the main discriminators between therapies for many patients.
Speaking to the limbic at AGW 2018, Professor Rupert Leong, from the University of Sydney, said patient preference still guided prescribing.
“The newer agents are designed to be safer – reducing opportunistic infection and cancer risk – so when that governs the discussion with patients in a prescribing situation, I would use those agents if that is most important criteria for the patients.”
“If they don’t want to be taking the risk of getting infection or they are elderly and using multiple drugs then I would steer toward vedolizumab and ustekimumab,” said Professor Leong, who is Director of Endoscopy at Concord Hospital.
He told the meeting that safety concerns were also important in young patients who would have a long duration of treatment and for women considering pregnancy.
A 2016 study had shown anti-TNFs, which included etanercept, infliximab, adalimumab, certolizumab and golimumab, taken during pregnancy did not significantly raise the risk of birth defects.
He said usual advice was to avoid vaccination with live vaccines such as rotavirus in infants under 12 months who had been exposed to biologics in utero.