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UK Patients of Bangladeshi Descent with Crohn’s Disease Respond Less Well to TNF Antagonists Than Caucasian Patients

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Abstract

Background

Patients with inflammatory bowel disease are currently managed with the assumption that trial data are applicable to all ethnic groups. Previous studies demonstrate differences in disease severity and phenotype of Asian patients with Crohn’s disease (CD), including Bangladeshi Asians within the UK. No study has evaluated the impact of ethnicity on response to anti-TNFs.

Aim

Our primary endpoint was a comparison of failure-free survival on first prescribed anti-TNF (anti-tumor necrosis factor) therapy in UK Bangladeshi and Caucasian patients with CD. Our secondary aims were to evaluate disease phenotype, indication for anti-TNF prescription, and duration from diagnosis until first anti-TNF prescribed between groups.

Methods

The records of consecutive outpatient appointments over a 12-month period were used to identify Caucasian and Bangladeshi patients prescribed an anti-TNF for CD. Information on patient demographics, ethnicity, disease phenotype, immunomodulator use, outcome from first biologic, duration of therapy, and reason for cessation was recorded.

Results

In total, 224 Caucasian and Bangladeshi patients were prescribed an anti-TNF for CD. Bangladeshi patients started an anti-TNF 4.3 years earlier after diagnosis than Caucasian patients (3.9 years vs. 8.2 years: p < 0.01). Bangladeshi patients experienced shorter failure-free survival than Caucasian patients (1.8 vs. 4.8 years p < 0.01). By 2 years, significantly more Bangladeshi patients had stopped anti-TNF due to loss of response (OR 6.35, p < 0.01).

Conclusions

This is the first study to suggest that Bangladeshi patients resident in the UK with CD respond less well to treatment with TNF antagonists than Caucasian patients.

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References

  1. Burisch J, Munkholm P. The epidemiology of inflammatory bowel disease. Scand J Gastroenterol. 2015;50:942–951.

    Article  Google Scholar 

  2. Côté-Daigneault J, Bouin M, Lahaie R, et al. Biologics in inflammatory bowel disease: what are the data? United Eur Gastroenterol J. 2015;3:419–428.

    Article  Google Scholar 

  3. Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130:323–333.

    Article  CAS  Google Scholar 

  4. Sandborn WJ, Hanauer SB, Rutgeerts P, et al. Adalimumab for maintenance treatment of Crohn’s disease: results of the CLASSIC II trial. Gut. 2007;56:1232–1239.

    Article  CAS  Google Scholar 

  5. Hanauer SB, Feagan BG, Lichtenstein GR, ACCENT I Study Group, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359:1541–1549.

    Article  CAS  Google Scholar 

  6. Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREAT™ registry. Am J Gastroenterol. 2012;107:1409–1422.

    Article  CAS  Google Scholar 

  7. Goh K, Xiao SD. Inflammatory bowel disease: a survey of the epidemiology in Asia. J Dig Dis. 2009;10:1–6.

    Article  Google Scholar 

  8. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.

    Article  Google Scholar 

  9. Carr I, Mayberry JF. The effects of migration on ulcerative colitis: a three-year prospective study among Europeans and first- and second- generation South Asians in Leicester (1991–1994). Am J Gastroenterol. 1999;94:2918–2922.

    CAS  PubMed  Google Scholar 

  10. Probert CS, Jayanthi V, Pollock DJ, et al. Crohn’s disease in Bangladeshis and Europeans in Britain: an epidemiological comparison in Tower Hamlets. Postgrad Med J. 1992;68:914–920.

    Article  CAS  Google Scholar 

  11. Rashid ST, Bharucha S, Jamallulail SI, et al. Inflammatory bowel disease in the South Asian population of Northwest England. Am J Gastroenterol. 2008;103:242–243.

    Article  Google Scholar 

  12. Park SJ, Kim WH, Cheon JH. Clinical characteristics and treatment of inflammatory bowel disease: a comparison of Eastern and Western perspectives. World J Gastroenterol. 2014;20:11525–11537.

    Article  Google Scholar 

  13. Farrukh A, Mayberry JF. Apparent discrimination in the provision of biologic therapy to patients with Crohn’s disease according to ethnicity. Public Health. 2015;129:460–464.

    Article  CAS  Google Scholar 

  14. Ng SC, Tsoi KK, Kamm MA, et al. Genetics of inflammatory bowel disease in Asia: systematic review and meta-analysis. Inflamm Bowel Dis. 2012;18:1164–1176.

    Article  Google Scholar 

  15. Ng SC. Emerging leadership lecture: Inflammatory bowel diseases in Asia: Emergency of a “Western” disease. J Gastroenterol Hepatol. 2015;30:440–445.

    Article  CAS  Google Scholar 

  16. Walker D, Williams H, Kane S, et al. Differences in inflammatory bowel disease phenotype between South Asians and Northern Europeans living in North West London, UK. Am J Gastroenterol. 2011;106:1281–1289.

    Article  Google Scholar 

  17. Nakase H, Keum B, Ye BD, et al. Treatment of inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 2(nd) Asian Organization of Crohn’s and Colitis (AOCC) meeting in Seoul. Intest Res. 2016;14:231–239.

    Article  Google Scholar 

  18. Goodhand JR, Kamperidis N, Joshi NM, et al. The phenotype and course of inflammatory bowel disease in UK patients of Bangladeshi descent. Aliment Pharmacol Ther. 2012;35:929–940.

    Article  CAS  Google Scholar 

  19. Carroll MW, Hamilton Z, Gill H, et al. Pediatric inflammatory bowel disease among South Asians living in British Columbia, Canada: a distinct clinical phenotype. Inflamm Bowel Dis. 2016;22:387–396.

    Article  Google Scholar 

  20. Ethnicity in Tower Hamlets. Analysis of 2011 census data. https://www.towerhamlets.gov.uk/Documents/Borough_statistics/Ward_profiles/Census-2011/RB-Census2011-Ethnicity-2013-01.pdf. Accessed October 1, 2017.

  21. NICE. Published technology appraisal guidance recommendations. https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-technology-appraisal-guidance/summary-of-decisions. Accessed October 1, 2017.

  22. Guo C, Wu K. Risk genes of inflammatory bowel disease in Asia: what are the most important pathways affected? Dig Dis. 2016;34:5–11.

    Article  Google Scholar 

  23. Prideaux L, Kang S, Wagner J, et al. Impact of ethnicity, geography, and disease on the microbiota in health and inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:2906–2918.

    Article  Google Scholar 

  24. Shi HY, Levy AN, Trivedi HD, et al. Ethnicity influences phenotype and outcomes in inflammatory bowel disease: a systematic review and meta-analysis of population-based studies. Clin Gastroenterol Hepatol. 2017;16:190.e11–197.e11.

    Google Scholar 

  25. Ng SC, Tang W, Ching JY, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-Pacific Crohn’s and colitis epidemiology study. Gastroenterology. 2013;145:158.e2–165.e2.

    Google Scholar 

  26. Ng SC, Zeng Z, Niewiadomski O, et al. Early course of inflammatory bowel disease in a population-based inception cohort study from 8 countries in Asia and Australia. Gastroenterology. 2016;150:86–95.

    Article  Google Scholar 

  27. Ahuja V, Tandon RK. Inflammatory bowel disease in the Asia-Pacific area: a comparison with developed countries and regional differences. J Dig Dis. 2010;11:134–147.

    Article  Google Scholar 

  28. Ng WK, Wong SH, Ng SC. Changing epidemiological trends of inflammatory bowel disease in Asia. Intest Res. 2016;14:111–119.

    Article  Google Scholar 

  29. Finlay DG, Basu D, Sellin JH. Effect of race and ethnicity on perceptions of inflammatory bowel disease. Inflamm Bowel Dis. 2006;12:503–507.

    Article  Google Scholar 

  30. Sandborn WJ, Feagan BG, Rutgeerts P, GEMINI 2 Study Group, et al. Vedolizumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2013;369:711–721.

    Article  CAS  Google Scholar 

  31. Feagan BG, Sandborn WJ, Gasink C, UNITI-IM-UNITI Study Group, et al. Ustekinumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2016;375:1946–1960.

    Article  CAS  Google Scholar 

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Author notes

  1. Radha Gadhok and Hannah Gordon contributed equally.

Authors and Affiliations

  1. Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK

    Radha Gadhok, Hannah Gordon, Gregory Sebepos-Rogers, Samantha Baillie, Saniath Akbar, Jane E. Abbott, Emma Michael, Omer F. Ahmad, Ben Cooper & James O. Lindsay

  2. The Blizard Institute, Centre for Immunology, Barts and the London School of Medicine, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK

    Radha Gadhok & Hannah Gordon

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  1. Radha Gadhok
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Correspondence to Radha Gadhok.

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Conflict of interest

Professor James O. Lindsay served as consultant and an advisory board participant for AbbVie, Actavis (Warner Chilcott), Atlantic Healthcare, Celtrion, Ferring, Jansen, MSD, Napp, Pfizer, Shire, Takeda and Vifor Pharma and has received investigator-led research grants from Hospira, Shire, and Takeda.

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Gadhok, R., Gordon, H., Sebepos-Rogers, G. et al. UK Patients of Bangladeshi Descent with Crohn’s Disease Respond Less Well to TNF Antagonists Than Caucasian Patients. Dig Dis Sci 65, 1790–1799 (2020). https://doi.org/10.1007/s10620-019-05907-w

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