Biologic Use Patterns and Predictors for Non-persistence and Switching of Biologics in Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Study

Jung, Yoon Suk; Han, Minkyung; Park, So Hee; Cheon, Jae Hee

doi:10.1007/s10620-019-05867-1

Cited by 26 publications

(32 citation statements)

References 26 publications

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“…27 In another Korean study, UC patients treated with infliximab had a lower risk of drug discontinuation than those treated with golimumab, as well as a lower risk of switching than patients treated with adalimumab and golimumab. 22 Reasons for the superiority of infliximab compared with other anti-TNF agents in terms of persistence and effectiveness have been hypothesized. Recent network meta-analyses on bio-naïve patients with UC have reported that infliximab was better than adalimumab for inducing clinical remission or responses and endoscopic improvement or mucosal healing, [28][29][30] and infliximab was also superior to golimumab for inducing endoscopic improvement or mucosal healing.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19][20] However, only limited data are available on suboptimal responses to anti-TNF therapy among UC patients in Asia, especially in the era of biologics other than nonanti-TNFs. 21,22 We aimed to identify suboptimal responses to anti-TNF therapies and differences between anti-TNF agents for UC patients in Korea using nationwide population-based data.…”

Section: Introductionmentioning

confidence: 99%

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Real-World Incidence of Suboptimal Response to Anti-Tumor Necrosis Factor Therapy for Ulcerative Colitis: A Nationwide Population-Based Study

et al. 2021

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Background/Aims: Although anti-tumor necrosis factor (TNF) agents have been widely used to treat ulcerative colitis (UC), the real-world incidence of suboptimal response to anti-TNF agents has not been thoroughly investigated, especially among Asians. Methods:Using the Korean National Health Insurance database, we collected data on UC patients who initiated anti-TNF agents between July 1, 2014, and June 30, 2017. We assessed suboptimal responses, including anti-TNF discontinuation or dose escalation, switching to other biologics, augmentation with a non-biologic therapy, and the requirement for colectomy.Results: A total of 1,268 patients were included as new anti-TNF users (infliximab 713, adalimumab 433, golimumab 122). The proportion of patients who experienced at least one suboptimal response within 1 year among all patients was 63.5%, including 59.1%, 69.5%, and 68.0% of patients treated with infliximab, adalimumab, and golimumab, respectively. The cumulative incidences of at least one suboptimal response over time were 41.5%, 63.7%, 80.5%, and 87.1% at 6, 12, 24, and 36 months, respectively. Cox proportional hazards modeling revealed that adalimumab was associated with a higher risk of at least one suboptimal response (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.13 to 1.48), dose escalation (HR, 4.35; 95% CI, 2.97 to 6.38) and discontinuation (HR, 1.25; 95% CI, 1.03 to 1.52) than infliximab. Golimumab was associated with a higher risk of switching to other biologics than infliximab (HR, 1.78; 95% CI, 1.21 to 2.60). Conclusions:More than half of Korean UC patients had suboptimal responses to anti-TNF agents within 1 year. UC patients treated with infliximab might be less prone to suboptimal responses than those treated with adalimumab or golimumab.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real-World Incidence of Suboptimal Response to Anti-Tumor Necrosis Factor Therapy for Ulcerative Colitis: A Nationwide Population-Based Study

et al. 2021

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“…However, HRU and direct costs after 36 months of follow-up were higher than the 24-month data, suggesting that some patients undergoing biologic treatment may not respond optimally after 24 months of treatment, and hence may have to switch treatment or undergo surgery to manage CD. This seems plausible since previous research has reported a reduction in persistence with biologics as time passes, with a wide range in the rate of non-persistence due to treatment discontinuation or switching [36][37][38][39].…”

Section: Plos Onementioning

confidence: 85%

Evaluation of economic burden with biologic treatments in Crohn’s disease patients: A mirror image study using an insurance database in Japan

Miyazaki¹,

Nagano²,

Huang³

et al. 2021

PLoS ONE

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Biologics are recommended in Japan to treat moderate to severe Crohn’s Disease (CD). Although CD is associated with high direct costs in Japan, updated information after ustekinumab’s approval is unavailable. We aimed to evaluate the healthcare resource utilization (HRU) and associated direct costs from the payer’s perspective in Japan. Claims data (2010–2018) were retrospectively analyzed to identify patients with CD. HRU and associated costs were evaluated for 12 months before and after biologic initiation and followed-up till 36 months post-initiation. Outcomes were reported using descriptive statistics. Among the included patients (n = 3,496), 1,783 were on biologics and 1,713 were on non-biologics. Mean (SD) age was 36.4 (13.2) years and patients were predominantly male (76.1%). Patients aged 18–39 years were affected with CD the most (55.3%). Biologic initiation was associated with a reduction in inpatient stay, length of stay, outpatient visits, and associated costs; and an increase in pharmacy costs and total costs after 12 months. Extended follow-up showed a decreasing trend in HRU and costs till 24 months but an increase after 36 months. These findings demonstrated reduction in clinical burden and slight increase in economic burden with biologics. However, indirect costs also need to be evaluated.

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“…Although different real-world studies have comparatively assessed the treatment patterns of various anti-TNF α therapies in IBD patients [13][14][15][16][17][18] , only a few of them have been conducted over a longer period of time. These few studies [13 , 17] are based on analyses of health insurance claims databases, which means that the data sources used are not clinical but administrative, with the well-known limitations of such claims data (poor disease characterization, a lack of data on the clinical reasons leading to medication changes, the impossibility of registering doses and dose adjustments, the need to use arbitrary definitions to draw conclusions on persistent gaps in treatment, or data quality strongly dependent on the accuracy of administrative coding tasks).…”

Section: Introductionmentioning

confidence: 99%

Treatment patterns and intensification within 5 year of follow-up of the first-line anti-TNFα used for the treatment of IBD: Results from the VERNE study

Bastida¹,

Marín-Jiménez²,

Forés³

et al. 2022

Digestive and Liver Disease

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Background: Anti-TNF α represent one of the main treatment approaches for the management of inflammatory bowel diseases (IBD). Therefore,the evaluation of their treatment patterns over time provides valuable insights about the clinical value of therapies and associated costs. Aims:To assess the treatment patterns with the first anti-TNF α in IBD.Methods: Retrospective, observational study.Results: 310 IBD patients were analyzed along a 5-year follow-up period. 56.2% of Crohn's disease (CD) patients started with adalimumab (ADA), while 43.8% started with infliximab (IFX). 12.9% of ulcerative colitis (UC) patients initiated with ADA, while 87.1% initiated with IFX. Treatment intensification was required in 28.9% of CD and 37.1% of UC patients. Median time to treatment intensification was shorter in UC than in CD (5.3 vs. 14.3 months; p = 0.028). Treatment discontinuation due to reasons other than remission were observed in 40.7% of CD and 40.5% of UC patients, although, in UC patients there was a trend to lower discontinuation rates with IFX (36.6%) than with ADA (66.7%). Loss of response accounted for approximately one-third of discontinuations, in both CD and UC.Conclusions: Around one-third of IBD biologic-naive patients treated with an anti-TNF α required treatment intensification (earlier in UC) and around 40% discontinued the anti-TNF α due to inappropriate disease control.

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Biologic Use Patterns and Predictors for Non-persistence and Switching of Biologics in Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Study

Cited by 26 publications

References 26 publications

Real-World Incidence of Suboptimal Response to Anti-Tumor Necrosis Factor Therapy for Ulcerative Colitis: A Nationwide Population-Based Study

Real-World Incidence of Suboptimal Response to Anti-Tumor Necrosis Factor Therapy for Ulcerative Colitis: A Nationwide Population-Based Study

Evaluation of economic burden with biologic treatments in Crohn’s disease patients: A mirror image study using an insurance database in Japan

Treatment patterns and intensification within 5 year of follow-up of the first-line anti-TNFα used for the treatment of IBD: Results from the VERNE study

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