Clinical Characteristics and Predictors of Biologic Failure in Inflammatory Bowel Disease: A Retrospective, Single-Center Study from Kuwait
Reem Aljabri*, Mohmmed Amr, Khaled Ghonim, Saqer Alsurraie and Ahmad Alhouti
ABSTARCT
Objectives: We aimed to identify the clinical characteristics and predictors of biologic failure in a real-world inflammatory bowel disease (IBD) cohort from Kuwait.
Methods: This retrospective, single-center study was conducted at Farwaniya Hospital, Kuwait, reviewing electronic medical records of IBD patients followed in 2024. The primary outcome was biologic failure, defined as a history of failing at least one biologic agent, necessitating a switch. Patient demographics, disease characteristics, and treatment history were compared between groups with and without a history of biologic failure.
Results: Among 297 patients (mean age 31.3±12.2 years; 62.3% male; 56.9% CD; current smoking 41.8%), prior biologic failure occurred in 24.9%. On univariate analysis, higher odds of failure were seen with Middle Eastern race, CD (vs UC), disease duration >5 years, colonic CD (L2), stricturing behaviors (B2), and perianal disease. On the other hand, 5-ASA use and current steroids were protective. In multivariable modelling, independent predictors of biologic failure were disease duration >5 years (adjusted OR [aOR] 2.78; 95% CI 1.51–5.10; p=0.001) and (B2) (aOR 2.62; 95% CI 1.19–5.77; p=0.016). 5-ASA therapy remained independently protective (aOR 0.06; 95% CI 0.02–0.22; p<0.001).
Conclusion: In this Kuwaiti IBD cohort, longer disease duration and stricturing CD behavior independently predicted biologic failure, whereas 5-ASA exposure was strongly protective. These findings support early risk stratification and mechanism-appropriate optimization (including timely biologic selection and therapeutic drug monitoring) to mitigate failure in high-risk patients in the Gulf region
