Gil Melmed, MD, is affiliated with Cedars-Sinai Inflammatory Bowel Disease Center.

Gil Melmed, MD

Which Biologic Lasts Longest for Crohn's Disease? Real-World Switch Rate Data Explained

With a growing roster of advanced therapies available for Crohn's disease (CD), treatment sequencing has become one of the most consequential decisions a gastroenterologist makes. While clinical trial data inform efficacy and safety, they do not capture what happens over the years a patient spends on a given drug in the real world.

A new claims-based analysis presented at Digestive Disease Week (DDW) 2026 in Chicago, IL, offers a different lens, taking a closer look at real-world switch rates. Gil Melmed, MD, a gastroenterologist at Cedars-Sinai, presented data from the US-payer claims database analysis examining real-world switching rates over 24 months among patients with CD initiating risankizumab, adalimumab, infliximab, ustekinumab, or vedolizumab.

“Switch rates are important when we think about therapies for Crohn's disease. It really gives us a sense of what is the anticipated persistence of a drug,” Melmed told 

. “When we offer chronic therapy to a patient with a chronic condition, there's only so much that we can tell from clinical trials, because clinical trials don't tell the whole story.”

The analysis drew on the Merative Marketscan database, identifying 5434 patients ≥ 18 years of age with ≥ 1 inpatient or 2 outpatient claims for CD who initiated a new biologic between January 2022 and July 2025. All patients had a minimum of 6 months of follow-up.

Nonswitching rates, defined as no claim for another advanced therapy, were assessed using Kaplan-Meier analysis over 24 months across the full population and the biologic-naïve subgroup. A Cox proportional hazards model adjusted for baseline differences including age, comorbidity burden, prior surgery, and prior biologic exposure.

At 24 months, risankizumab demonstrated the lowest estimated switch rate of any biologic assessed (14.0% across all patients, 13.4% in the biologic-naïve subgroup). Ustekinumab followed at 21.1% and 19.3%, respectively, with vedolizumab, infliximab, and adalimumab trailing further behind, the latter reaching a switch rate of 36.0% in the overall population.

Of note, the advantage of risankizumab was most pronounced in biologic-naïve patients, consistent with the broader principle that first-line advanced therapy offers the best opportunity for durable response. However, the advantage still persisted even among patients with prior biologic exposure.

“For risankizumab, that switch rate of the persistence of the drug requiring to go on to a different therapy is lowest in risankizumab, meaning that switch rate is lower than it is with other drugs,” Melmed explained. “This effect is more pronounced in patients who are naive to other therapies, as opposed to patients who have previously been on other therapies. And we see that with risankizumab being the lowest switch rate, even in patients who have also been on prior advanced therapies.”

Melmed emphasized that real-world persistence data capture the aggregate effect of efficacy, tolerability, and patient experience over time, something clinical trials cannot. A patient who stops a drug for any reason shows up in switch rate data, making it a composite reflection of how a therapy performs outside of protocol-driven conditions.

The findings are also consistent with switch rate data for risankizumab in other immune-mediated conditions, including psoriasis and psoriatic arthritis, suggesting a durable treatment profile that may extend across indications.

Melmed noted that the claims data did not capture the reasons behind individual switching decisions, an acknowledged limitation that future analyses should aim to address.

Editor's note: Melmed reports relevant disclosures with AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Genentech, Gilead, Janssen, Medtronic, Merck, Prometheus Labs, Pfizer, Takeda, and others.

Melmed G, Ungaro RC, Griffith J, et al. Real-World Switching Rates Among Patients With Crohn's Disease Treated With Biologics in the United States. Presented at Digestive Disease Week (DDW) 2026; Chicago, IL; May 2–5, 2026.

Teeple A, Sah J, Mallampati R, et al. Persistence, Dosing, and Other Treatment Patterns Among Crohn's Disease Patients Initiating Biologics in United States. 

. 2021;3(4):otab076. Published 2021 Nov 5. doi:10.1093/crocol/otab076

Videos

Gil Melmed, MD, breaks down real-world data showing risankizumab has the lowest switch rates in Crohn’s over 24 months, highlighting strong persistence vs other biologics.

Gil Melmed, MD

Articles