2920 Prior Pharmacotherapy Patterns Among Patients With IBD in the USA Initiating Biologic Therapy

Abstract

INTRODUCTION: Treatment for inflammatory bowel disease (IBD: Crohn's disease [CD] and ulcerative colitis [UC]) has shifted from symptom management using corticosteroids to targeted therapies such as tumor necrosis factor (TNF) inhibitors. Increasing therapeutic options warrants a better understanding of current treatment pathways. This study reports on the pharmacotherapy history of patients with CD and UC prior to initiation of an IBD-targeted biologic. METHODS: Using the IQVIATM Real-World Data Adjudicated Claims Database – US, we identified adults (≥18 years) with CD or UC who initiated biologic treatment from Jan 1, 2016 to Jun 30, 2017. Analysis was limited to biologics indicated for CD/UC during the study period. Patients were stratified based on most recent biologic received; the date of initiation was designated the index date. Patients with <12 months of continuous medical coverage prior to the index date were excluded. Patterns of prior IBD-related pharmacotherapy, in terms of number and type of biologics, and time spent on the biologic, were examined in relation to the index biologic, for the study period Jan 1, 2011 to Jun 30, 2017. RESULTS: A total of 5210 patients with CD and 3010 with UC were identified. Among patients with CD, 2634, 1436, 737, 241 and 162 began treatment with adalimumab, infliximab, vedolizumab, certolizumab, and ustekinumab, respectively. Among patients with UC, 1285, 977, 587 and 161 initiated treatment with adalimumab, infliximab, vedolizumab and golimumab, respectively. Most patients beginning treatment with infliximab or adalimumab were previously biologic-naïve (CD: 77.8%, 84.6%, respectively; UC: 79.9%, 89.3%, respectively). Patients starting treatment with other biologics, however, typically had received at least one IBD-related biologic previously (Figure 1). Among patients who were not biologic-naïve at initiation of therapy, mean total duration of prior exposure was 26.6 and 17.8 months for patients with CD and UC, respectively. CONCLUSION: While newer IBD-related biologics (i.e., vedolizumab, ustekinumab) are typically preceded by treatment with other biologics, most patients receiving one of the first biologics approved for IBD (i.e., infliximab, adalimumab) are biologic-naïve. Patients with a treatment history of two biologics had a longer overall period of biologic exposure than those who had previously received only one biologic.