Open AccessPersistence, Dosing, and Other Treatment Patterns Among Crohn’s Disease Patients Initiating Biologics in United States
Author(s) -
Amanda Teeple,
Janvi Sah,
Rajesh Mallampati,
Christopher M. Adams,
Dexter Waters,
Erik Muser
Publication year - 2021
Publication title -
crohn's and colitis 360
Language(s) - English
Resource type - Journals
ISSN - 2631-827X
DOI - 10.1093/crocol/otab076
Subject(s) - vedolizumab , medicine , certolizumab pegol , dosing , infliximab , adalimumab , persistence (discontinuity) , ustekinumab , maintenance therapy , post hoc analysis , crohn's disease , disease , chemotherapy , engineering , geotechnical engineering
Background This study examined biologic persistence, dosing, and other treatment patterns among Crohn’s disease (CD) patients that initiated adalimumab (ADA), certolizumab pegol (CZP), infliximab (IFX), ustekinumab (UST), and vedolizumab (VDZ). Methods This descriptive study pooled data from IBM MarketScan, IQVIA PharMetrics, and Optum databases and identified CD patients who initiated the above biologics. Due to low sample size, CZP was not included in the analyses. Persistence was defined as the proportion of patients that remained on the index biologic without a gap of >30 days for ADA and >120 days for UST, IFX, and VDZ between two claims. A sensitivity analysis using fixed gap (90-day) was also conducted. Dose titration (based upon mean maintenance dose) including 50% dose escalation, and 50% dose reduction was assessed among patients with ≥2 maintenance doses during follow-up among ADA, UST, and VDZ patients. Results After applying all selection criteria, patients were selected into bio-naive (ADA: 2047; IFX: 1127; UST: 296; VDZ: 342) and bio-experienced cohorts (ADA: 300; IFX: 341; UST: 801; VDZ: 593) based on the biologics used. Unadjusted persistence was numerically higher among bio-naive and bio-experienced UST (87.2%, 86.3%) patients followed by VDZ (78.9%, 80.8%), IFX (79.0%, 77.4%), and ADA (64.9%, 60.7%). Similar trends were observed using sensitivity analysis. Dose escalation was numerically higher for ADA patients (16.1%–16.4%) followed by UST (13.4%–16.9%), and VDZ (12.4%–14.7%). Dose reduction followed a similar trend. Conclusions Among CD patients, unadjusted persistence using variable and fixed gap definition was numerically highest for UST patients whereas dose escalation was numerically highest among ADA patients. Further research is needed to examine treatment patterns after adjusting for confounders and baseline differences among biologic users.