826 Biologic Use in Pediatric Patients Newly Diagnosed With Crohn’s Disease in the United States, 2010-2013 and 2014-2016

Abstract

INTRODUCTION: The purpose of this study is to characterize treatment patterns and sequences of biologic initiation in pediatric patients newly diagnosed with Crohn’s Disease (CD) in the United States in 2010-2013 and 2014-2016. METHODS: Pediatric (0-17 years) patients with ≥2 CD diagnosis codes (ICD-9: 555.x; ICD-10:K50.x) from October 1, 2010 to September 30, 2016 were included in this retrospective analysis of medical and pharmacy claims data from the IBM Marketscan Commercial and Medicaid Claims database. Patients were excluded if they were >18 years old, had an Ulcerative Colitis (UC) diagnosis, had a dual UC and CD diagnosis, or did not have treatment throughout the study period. Pathway visualization techniques and subgroups analyses were conducted for the 2 years post diagnosis to compare biologic use following first diagnosis during 2010-2013 and 2014-2016. Two-sample t test were conducted for continuous patient characteristics between 2010 -2013 and 2014-2016 diagnosis periods. Chi-square tests were used to compare categorical variables. RESULTS: A cohort of 940 CD patients were identified with 482 (51.3%) diagnosed with CD during 2010-13 and 458 (48.7%) diagnosed during 2014-16. The majority of patients during both time periods were male. Mean age at diagnosis was not statistically different during 2010-2013 and 2014-2016 (13.4 vs. 13.5 years; P = 0.75). In general, the majority of patients initiated conventional treatment (aminosalicylates, immunomodulators, and/or corticosteroids) at the time of diagnosis. However, there was a statistically significant increase in biologic use from 43.6% of patients in 2010-2013 to 59.8% of patients in 2014-2016 (P < 0.001). The median time to biologic treatment in the 2 years post diagnosis was 173.0 days for those diagnosed 2010-13 versus 76.5 days for those diagnosed during 2014-16 (P < 0.001). Infliximab was more frequently identified as the first-line biologic in the 2 years post diagnosis for those diagnosed 2010-13 and 2014-2016, yet rates of infliximab were low. However, pathway visualization Sankey diagrams illustrated limited switching from one biologic to another after initiation of biologic therapy during the 2 years post diagnosis for 2010-13 (Figure 1), with no predominant sequence identified. This trend remained for the 2014-16 cohort (Figure 2). CONCLUSION: Biologic use among pediatric CD patients has increased in recent years; however conventional treatment is still more common at the time of diagnosis.