@article {Akbar490, author = {Ayesha Akbar and Tim Orchard and Nick Powell and Christian Selinger and Clare tibbatts}, title = {Influence of comorbidities on treatment considerations for first-line biologic prescribing in patients with inflammatory bowel disease in the UK}, volume = {13}, number = {6}, pages = {490--496}, year = {2022}, doi = {10.1136/flgastro-2021-101995}, publisher = {British Medical Journal Publishing Group}, abstract = {Background Anti-tumour necrosis factor (anti-TNF) therapies are the most commonly used biologics for inflammatory bowel disease (IBD), but for patients with a comorbidity, newer agents may be a more appropriate treatment choice.Aims To investigate the impact of comorbidities in patients with IBD, on first-line biologic prescribing habits of IBD-specialist healthcare practitioners in the UK.Methods IBD-specialist physicians and nurses were asked to answer an online survey, considering different prescribing scenarios in ulcerative colitis (UC) and Crohn{\textquoteright}s disease (CD). Respondents could indicate a preference for anti-TNFs or newer biologics, both in the absence and presence of 10 common comorbidities.Results A total of 120 IBD-specialist healthcare professionals (HCPs) completed the survey. In the absence of comorbidities, anti-TNFs were favoured; infliximab was the preferred first-line biologic in both UC and CD (43\% and 37\% of respondents, respectively). On introducing comorbidities, the largest shift in prescribing behaviour was for vedolizumab, with preference increasing by 27\% and 21\%, compared with infliximab, which fell by 14\% and 9\% in UC and CD, respectively. Chronic/recurring infection (46\%), congestive heart failure (<=44\%) and malignancies (<=43\%) were the most commonly selected comorbidities for vedolizumab treatment.Conclusions Clinicians adapt their biologic prescribing habits in patients with IBD with comorbidities, considering known contraindications and precautions. A preference for vedolizumab is evident in many cases, however, for several comorbid scenarios, including demyelinating disorders, chronic obstructive pulmonary disease and malignancy, anti-TNFs are prescribed despite known risks. It is important that continual re-evaluation of the IBD treatment landscape is undertaken by HCPs, in alignment with recommendations in published guidelines.Data available within the article or its supplementary materials. Not applicable.}, issn = {2041-4137}, URL = {https://fg.bmj.com/content/13/6/490}, eprint = {https://fg.bmj.com/content/13/6/490.full.pdf}, journal = {Frontline Gastroenterology} }