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Impact of Biologic Treatment of Crohn’s Disease on the Rate of Surgeries and Other Healthcare Resources: An Analysis of a Nationwide Database From Poland

Background: There is conflicting evidence on the impact of biologic treatment on the rate of complications and surgeries in Crohn’s disease (CD). We aimed to assess real-world consequences of biologic treatment of CD. Methods: All adult patients with CD treated with infliximab and adalimumab in the...

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Autores principales: Holko, Przemysław, Kawalec, Paweł, Pilc, Andrzej
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004509/
https://www.ncbi.nlm.nih.gov/pubmed/29942260
http://dx.doi.org/10.3389/fphar.2018.00621
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author Holko, Przemysław
Kawalec, Paweł
Pilc, Andrzej
author_facet Holko, Przemysław
Kawalec, Paweł
Pilc, Andrzej
author_sort Holko, Przemysław
collection PubMed
description Background: There is conflicting evidence on the impact of biologic treatment on the rate of complications and surgeries in Crohn’s disease (CD). We aimed to assess real-world consequences of biologic treatment of CD. Methods: All adult patients with CD treated with infliximab and adalimumab in the years 2012–2014 were identified from the database of the National Health Fund in Poland. Mixed models were used to assess the impact of biologics on medical resource utilization by comparing the periods before and after the first use of biologics (pre-index vs. post-index). The additional analyses including quintile of total exposure to biologic treatment were performed. Results: Data on 1393 patients (age, 31.9 years; males, 52.6%) were analyzed over a median of 1064 days (range: 71, 1148). During the post-index period, patients received from one to four treatments with biologic agents (maximum allowed period of 12 months per treatment). We observed a reduction in the rates of surgeries (by 27%, p = 0.001), hospitalizations for CD excluding surgical procedures (by 45%, p < 0.001), as well as consumption of antibiotics (by 31%, p < 0.001) and steroids (by 35%, p < 0.001) in the post-index compared with the pre-index period. The reduction in the rate of surgeries, hospitalizations for CD, and steroid intake increased with the increase of exposure to biologic agents. Conclusion: Biologic treatment changed the management patterns by lowering the rate of surgeries and other healthcare resources related to complications or worsening of CD. The reduction in the resource utilization was dependent on the level of exposure to treatment, suggesting that limitation of the treatment period itself may be inadequate.
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spelling pubmed-60045092018-06-25 Impact of Biologic Treatment of Crohn’s Disease on the Rate of Surgeries and Other Healthcare Resources: An Analysis of a Nationwide Database From Poland Holko, Przemysław Kawalec, Paweł Pilc, Andrzej Front Pharmacol Pharmacology Background: There is conflicting evidence on the impact of biologic treatment on the rate of complications and surgeries in Crohn’s disease (CD). We aimed to assess real-world consequences of biologic treatment of CD. Methods: All adult patients with CD treated with infliximab and adalimumab in the years 2012–2014 were identified from the database of the National Health Fund in Poland. Mixed models were used to assess the impact of biologics on medical resource utilization by comparing the periods before and after the first use of biologics (pre-index vs. post-index). The additional analyses including quintile of total exposure to biologic treatment were performed. Results: Data on 1393 patients (age, 31.9 years; males, 52.6%) were analyzed over a median of 1064 days (range: 71, 1148). During the post-index period, patients received from one to four treatments with biologic agents (maximum allowed period of 12 months per treatment). We observed a reduction in the rates of surgeries (by 27%, p = 0.001), hospitalizations for CD excluding surgical procedures (by 45%, p < 0.001), as well as consumption of antibiotics (by 31%, p < 0.001) and steroids (by 35%, p < 0.001) in the post-index compared with the pre-index period. The reduction in the rate of surgeries, hospitalizations for CD, and steroid intake increased with the increase of exposure to biologic agents. Conclusion: Biologic treatment changed the management patterns by lowering the rate of surgeries and other healthcare resources related to complications or worsening of CD. The reduction in the resource utilization was dependent on the level of exposure to treatment, suggesting that limitation of the treatment period itself may be inadequate. Frontiers Media S.A. 2018-06-11 /pmc/articles/PMC6004509/ /pubmed/29942260 http://dx.doi.org/10.3389/fphar.2018.00621 Text en Copyright © 2018 Holko, Kawalec and Pilc. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Holko, Przemysław
Kawalec, Paweł
Pilc, Andrzej
Impact of Biologic Treatment of Crohn’s Disease on the Rate of Surgeries and Other Healthcare Resources: An Analysis of a Nationwide Database From Poland
title Impact of Biologic Treatment of Crohn’s Disease on the Rate of Surgeries and Other Healthcare Resources: An Analysis of a Nationwide Database From Poland
title_full Impact of Biologic Treatment of Crohn’s Disease on the Rate of Surgeries and Other Healthcare Resources: An Analysis of a Nationwide Database From Poland
title_fullStr Impact of Biologic Treatment of Crohn’s Disease on the Rate of Surgeries and Other Healthcare Resources: An Analysis of a Nationwide Database From Poland
title_full_unstemmed Impact of Biologic Treatment of Crohn’s Disease on the Rate of Surgeries and Other Healthcare Resources: An Analysis of a Nationwide Database From Poland
title_short Impact of Biologic Treatment of Crohn’s Disease on the Rate of Surgeries and Other Healthcare Resources: An Analysis of a Nationwide Database From Poland
title_sort impact of biologic treatment of crohn’s disease on the rate of surgeries and other healthcare resources: an analysis of a nationwide database from poland
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004509/
https://www.ncbi.nlm.nih.gov/pubmed/29942260
http://dx.doi.org/10.3389/fphar.2018.00621
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