A Retrospective Claims Database Study of Treatment Patterns for Patients Newly Diagnosed with Ulcerative Colitis or Crohnʼs Disease from 2009-2014: Reduced Use of Aminosalicylates and Increase in Biologic Therapy: 2016 ACG Category Award (Outcomes Research) 2016 ACG Presidential Poster Award

Abstract

Introduction: New medications for inflammatory bowel disease offer more treatment options for patients (pts) with ulcerative colitis (UC) and Crohn's disease (CD). This study examines real-world claims data for pts newly diagnosed with UC or CD to identify changes in treatment patterns over a 5-yr period and to investigate differences in treatment based on pt age. Methods: Newly diagnosed UC or CD pts from a 5-yr index period (2009-2014) were selected from the MarketScan Commercial and Medicare Databases (2007-2015). Pts were required to have continuous enrollment for ≥12-months pre- and post-index. The first UC or CD diagnosis was set as the index date. Treatment patterns over the index period were examined for UC and CD cohorts by age subgroups (adult: ≥18 yr, adolescent: 12-17 yr, juvenile: < 12 yr). Results: A total of 56,597 UC and 40,117 CD pts were selected; 45.4% of UC and 44.0% of CD pts were male. The majority were adults (UC: 97%; CD: 92%), followed by adolescents (UC: 3%; CD: 5%) and juveniles (UC: 1%; CD: 3%). Across index yrs 2009-2014, there was a slight increase in the proportion of newly diagnosed pts in both cohorts who did not file claims for any pharmacological treatment (Table 1). Overall, the rate of untreated pts was lowest among adolescents in both cohorts (UC: adults 9.5%, adolescents 4.8%, juveniles 12.4%; CD: adults 12.0%, adolescents 6.7%, juveniles 11.9%). Over 2009-2014, the majority of all UC and CD pts were treated with nonbiologics including aminosalicylates (5-ASA) and corticosteroids (CS). Biologic treatment rates remained low over 2009-2014 with a small uptick (5.6% to 7.2% for UC, 17.4% to 19.8% for CD). When restricting to the first-line treatment, use of 5-ASA declined over time and there was anincrease in CS prescriptions from 2009-2014 in both UC and CD pts (Table 1). On average, it took 94 days vs 109 days for UC vs CD pts to initiate the first line of therapy. Over the index period, the mean number of days to initiate treatment declined and the duration on the first line of therapy decreased for both cohorts (Table 1).Table 1: Treatment Patterns for Patients Newly Diagnosed With Ulcerative Colitis or Crohn's Disease by Index YearConclusion: This real-world assessment of treatment patterns in pts with newly diagnosed UC or CD from 2009-2014 indicates there is a decrease in 5-ASA use in UC and CD as first-line of therapy and a marginal increase in biologic therapy over time. Although the number of days to first line of therapy decreased over the study period by index year, there are still pts who did not receive any treatment.