738 Current Treatment Patterns Among Patients With IBD in the U.S. Initiating Biologic Therapy

Abstract

INTRODUCTION: Treatment options for inflammatory bowel disease (IBD: Crohn's disease [CD] and ulcerative colitis [UC]) now include targeted therapies such as tumor necrosis factor (TNF) inhibitors and integrin receptor antagonists. With increasing therapeutic options, it is crucial to understand clinical use of these agents. This study reports on the current pattern and duration of biologic use in patients with IBD. METHODS: Adults (≥18 years) with CD or UC who initiated treatment with biologics between January 1, 2012 and December 31, 2016 were identified using the IQVIATM Real-World Data Adjudicated Claims Database – US. Treatment episode duration was defined as time from first (index date) to final receipt, identified based on a ≥90-day gap in therapy, surgery for IBD, or therapy switching, whichever came first. In patients with CD or UC who had ≥2 claims for biologics, we examined length of treatment episodes by product as well as for biologics overall. Kaplan–Meier (KM) methods were used. RESULTS: We identified a total of 18,140 and 11,474 patients with CD and UC, respectively, who began treatment with a biologic for IBD during the study period and had not received a biologic prior to January 1, 2012. Over an average follow-up of 22.9 months, the mean duration of biologic treatment was 13.5 months (CD: 13.7; UC: 13.1). After 12 and 24 months of treatment, 7.0% (CD: 7.2%; UC: 6.8%) and 11.0% (CD: 11.2%; UC: 10.6%) of patients beginning biologic therapy had undergone surgery for IBD, respectively. The number of patients beginning treatment with individual biologics is presented in Figure 1. Among patients starting treatment with adalimumab or infliximab, ∼10% had previously received another biologic during the 6-month period prior to index date for that biologic, compared with ∼30–40% of patients starting treatment with other biologics. The mean duration of treatment with adalimumab or infliximab was 12.2 months. Treatment episodes were shorter for other biologics (shortest duration: 4.8 months for patients with CD beginning ustekinumab). By month 6 of treatment, KM estimates of the percentage of patients with CD starting another IBD biologic ranged from 4.1% (ustekinumab) to 8.1% (certolizumab); for UC, the range was 3.6% (vedolizumab) to 15.9% (golimumab). CONCLUSION: Most patients starting biologic therapy have no evidence of prior receipt of IBD-related biologics. Duration of biologic treatment for IBD averages approximately 1 year for adalimumab and infliximab but is shorter for other agents.