Cargando…

Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn’s Disease Initiating Biologics With 3 Years of Follow-Up

Background: There is limited real-world evidence on treatment patterns of patients with Crohn’s disease (CD) initiating biologics with an extensive follow-up period. This study describes persistence and dose titration among CD patients with 3 years of follow-up. Methods: This retrospective observati...

Descripción completa

Detalles Bibliográficos
Autores principales: Zhao, Ruizhi, Ding, Zhijie, Gupta, Parul, Gozalo, Laurence, Bruette, Robert, Johnson, Victor M., Maughn, Keshia, Liu, Yihang, Kachroo, Sumesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Columbia Data Analytics, LLC 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664831/
https://www.ncbi.nlm.nih.gov/pubmed/38025989
http://dx.doi.org/10.36469/001c.88947
_version_ 1785148797655973888
author Zhao, Ruizhi
Ding, Zhijie
Gupta, Parul
Gozalo, Laurence
Bruette, Robert
Johnson, Victor M.
Maughn, Keshia
Liu, Yihang
Kachroo, Sumesh
author_facet Zhao, Ruizhi
Ding, Zhijie
Gupta, Parul
Gozalo, Laurence
Bruette, Robert
Johnson, Victor M.
Maughn, Keshia
Liu, Yihang
Kachroo, Sumesh
author_sort Zhao, Ruizhi
collection PubMed
description Background: There is limited real-world evidence on treatment patterns of patients with Crohn’s disease (CD) initiating biologics with an extensive follow-up period. This study describes persistence and dose titration among CD patients with 3 years of follow-up. Methods: This retrospective observational study was conducted using the STATinMED RWD Insights all-payer medical and pharmacy data. Adult patients with at least 1 CD medical claim and at least 1 medical/pharmacy claim for a biologic (adalimumab [ADA], certolizumab pegol (CZP), infliximab [IFX] and its biosimilar products [IFX-BS], ustekinumab [UST], and vedolizumab [VDZ]) between September 2016 and October 2018 were identified. Commercially insured patients with continuous capture for at least 12 months before and at least 36 months after biologics initiation were selected. Confirmed CD patients were included in the final cohort. Baseline patient characteristics and treatment patterns over the 3-year follow-up period were evaluated. Results were summarized using means and SD or counts and percentages. Results: A total of 2309 confirmed patients with CD were identified (847 [36.7%] IFX, 534 [23.1%] ADA, 486 [21.1%] VDZ, 394 [17.1%] UST, 85 [3.7%] CZP, and 72 [3.1%] IFX-BS). CZP and IFX-BS were excluded due to small sample sizes. Approximately half of CD patients were between ages 35 and 54. Patients on UST had a higher Charlson Comorbidity Index score. Common comorbidities (>10%) included anemia, anxiety, depression, and hypertension. Persistence over 3 years’ follow-up was highest for UST (61.4%) patients, followed by VDZ (58.0% ), ADA (52.1% , and IFX (48.1%). The discontinuation rate without switch or restart was highest for ADA (37.3%), followed by UST (30.7%), IFX (28.1%), and VDZ (25.3%). Over the 3 years of follow-up, the dose titration rate was highest for IFX (76.5%) and lowest for UST (50.8%). In particular, UST had the lowest dose escalation rate (35.5%) and highest dose-reduction rate (16.5%). Conclusions: Patients with CD on UST had the highest persistence and lowest dose escalation across different biologic users over the 3-year follow-up period, possibly suggesting a better clinical response of UST. Future studies with longer follow-up adjusting for confounders are needed to better understand treatment patterns among biologics users.
format Online
Article
Text
id pubmed-10664831
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Columbia Data Analytics, LLC
record_format MEDLINE/PubMed
spelling pubmed-106648312023-11-20 Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn’s Disease Initiating Biologics With 3 Years of Follow-Up Zhao, Ruizhi Ding, Zhijie Gupta, Parul Gozalo, Laurence Bruette, Robert Johnson, Victor M. Maughn, Keshia Liu, Yihang Kachroo, Sumesh J Health Econ Outcomes Res Gastrointestinal Conditions Background: There is limited real-world evidence on treatment patterns of patients with Crohn’s disease (CD) initiating biologics with an extensive follow-up period. This study describes persistence and dose titration among CD patients with 3 years of follow-up. Methods: This retrospective observational study was conducted using the STATinMED RWD Insights all-payer medical and pharmacy data. Adult patients with at least 1 CD medical claim and at least 1 medical/pharmacy claim for a biologic (adalimumab [ADA], certolizumab pegol (CZP), infliximab [IFX] and its biosimilar products [IFX-BS], ustekinumab [UST], and vedolizumab [VDZ]) between September 2016 and October 2018 were identified. Commercially insured patients with continuous capture for at least 12 months before and at least 36 months after biologics initiation were selected. Confirmed CD patients were included in the final cohort. Baseline patient characteristics and treatment patterns over the 3-year follow-up period were evaluated. Results were summarized using means and SD or counts and percentages. Results: A total of 2309 confirmed patients with CD were identified (847 [36.7%] IFX, 534 [23.1%] ADA, 486 [21.1%] VDZ, 394 [17.1%] UST, 85 [3.7%] CZP, and 72 [3.1%] IFX-BS). CZP and IFX-BS were excluded due to small sample sizes. Approximately half of CD patients were between ages 35 and 54. Patients on UST had a higher Charlson Comorbidity Index score. Common comorbidities (>10%) included anemia, anxiety, depression, and hypertension. Persistence over 3 years’ follow-up was highest for UST (61.4%) patients, followed by VDZ (58.0% ), ADA (52.1% , and IFX (48.1%). The discontinuation rate without switch or restart was highest for ADA (37.3%), followed by UST (30.7%), IFX (28.1%), and VDZ (25.3%). Over the 3 years of follow-up, the dose titration rate was highest for IFX (76.5%) and lowest for UST (50.8%). In particular, UST had the lowest dose escalation rate (35.5%) and highest dose-reduction rate (16.5%). Conclusions: Patients with CD on UST had the highest persistence and lowest dose escalation across different biologic users over the 3-year follow-up period, possibly suggesting a better clinical response of UST. Future studies with longer follow-up adjusting for confounders are needed to better understand treatment patterns among biologics users. Columbia Data Analytics, LLC 2023-11-20 /pmc/articles/PMC10664831/ /pubmed/38025989 http://dx.doi.org/10.36469/001c.88947 Text en https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (4.0) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Gastrointestinal Conditions
Zhao, Ruizhi
Ding, Zhijie
Gupta, Parul
Gozalo, Laurence
Bruette, Robert
Johnson, Victor M.
Maughn, Keshia
Liu, Yihang
Kachroo, Sumesh
Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn’s Disease Initiating Biologics With 3 Years of Follow-Up
title Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn’s Disease Initiating Biologics With 3 Years of Follow-Up
title_full Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn’s Disease Initiating Biologics With 3 Years of Follow-Up
title_fullStr Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn’s Disease Initiating Biologics With 3 Years of Follow-Up
title_full_unstemmed Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn’s Disease Initiating Biologics With 3 Years of Follow-Up
title_short Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn’s Disease Initiating Biologics With 3 Years of Follow-Up
title_sort evaluation of treatment patterns and maintenance dose titration among patients with crohn’s disease initiating biologics with 3 years of follow-up
topic Gastrointestinal Conditions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664831/
https://www.ncbi.nlm.nih.gov/pubmed/38025989
http://dx.doi.org/10.36469/001c.88947
work_keys_str_mv AT zhaoruizhi evaluationoftreatmentpatternsandmaintenancedosetitrationamongpatientswithcrohnsdiseaseinitiatingbiologicswith3yearsoffollowup
AT dingzhijie evaluationoftreatmentpatternsandmaintenancedosetitrationamongpatientswithcrohnsdiseaseinitiatingbiologicswith3yearsoffollowup
AT guptaparul evaluationoftreatmentpatternsandmaintenancedosetitrationamongpatientswithcrohnsdiseaseinitiatingbiologicswith3yearsoffollowup
AT gozalolaurence evaluationoftreatmentpatternsandmaintenancedosetitrationamongpatientswithcrohnsdiseaseinitiatingbiologicswith3yearsoffollowup
AT bruetterobert evaluationoftreatmentpatternsandmaintenancedosetitrationamongpatientswithcrohnsdiseaseinitiatingbiologicswith3yearsoffollowup
AT johnsonvictorm evaluationoftreatmentpatternsandmaintenancedosetitrationamongpatientswithcrohnsdiseaseinitiatingbiologicswith3yearsoffollowup
AT maughnkeshia evaluationoftreatmentpatternsandmaintenancedosetitrationamongpatientswithcrohnsdiseaseinitiatingbiologicswith3yearsoffollowup
AT liuyihang evaluationoftreatmentpatternsandmaintenancedosetitrationamongpatientswithcrohnsdiseaseinitiatingbiologicswith3yearsoffollowup
AT kachroosumesh evaluationoftreatmentpatternsandmaintenancedosetitrationamongpatientswithcrohnsdiseaseinitiatingbiologicswith3yearsoffollowup