Comparison of Real-World Treatment Patterns for Patients Newly Diagnosed with Ulcerative Colitis or Crohnʼs Disease Who Receive Early vs Late Biologic Therapy: 2016 ACG Presidential Poster Award

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Introduction: Historical (or older) treatment guidelines for ulcerative colitis (UC) and Crohn's disease (CD) recommend initial intervention with aminosalicylates (5-ASA), stepping up to steroids and offering biologics after other treatments fail. Recently, early intensive use of biologic therapy has demonstrated improved treatment outcomes.1 This study aims to examine real-world treatment strategies for newly diagnosed UC or CD patients and to highlight differences between patients who receive early intensive therapy compared with those who follow traditional treatment regimens. Methods: Newly diagnosed UC and CD patients during 2009-2014 were identified from Truven MarketScan Commercial and Medicare Databases. Patients with ≥1 inpatient or ≥2 outpatient diagnoses of UC or CD during the index period were selected; the first UC/CD diagnosis was set as the index date. Patients were required to have continuous enrollment for ≥12-months pre-index and postindex. UC or CD patients who received biologic therapy were identified and stratified into subgroups based on the start date of biologic use: early users initiated ≤90 days from index date vs late users initiated >90 days from index date. Treatment patterns including biologic discontinuation, treatment switching, dose escalations, and augmentation were compared between early and late biologic users. Results: Among newly diagnosed UC and CD patients, only 3,513 (6.2%) of UC and 7,197 (17.9%) of CD patients had claims for treatment with ≥1 biologic therapy. Of those on biologic therapy, early use was reported in 26.1% of UC patients and 39.9% of CD patients. During 2009-2014, patients who received early biologics increased from 22.6% to 46.8% for UC and 36.0% to 55.4% for CD patients by index year. Conclusion: Data from this real-world assessment of treatment patterns for patients newly diagnosed with UC or CD indicate that very few patients are treated with early intensive use of biologic therapy. However, there has been some movement toward earlier use of biologics in more recent years. Patients with early biologic use stay on that treatment longer than those starting later and are more likely to have dose optimization.Table 1: Treatment Pattern for Patients Who Receive Early vs Late Treatment With Biologic Therapy