PGI42 - NON-PERSISTENCE WITH IMMUNOSUPPRESANT, ANTI-TUMOR NECROSIS FACTOR, AND ANTI-INTEGRIN AGENTS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE CLAIMS DATA ANALYSIS IN GERMANY

Abstract

The aim of this study was to assess non-persistence (NP) with immunosuppressant (IS), anti-tumor necrosis factor (aTNF) and anti-integrin (aI) treatment in IBD patients. We conducted a retrospective claims data analysis (AOK PLUS database) of ulcerative colitis (UC) or Crohn’s disease (CD) patients who were newly initiating a treatment with IS, aTNF or aI from 01/01/2013-31/12/2015. NP was defined as drug coverage gap >60 days, and was reported after 12, 24, and 36 months, censoring for death and end of follow-up period. Cox regression analysis was used to identify differences in mean persistence between the 3 treatment groups. 1,126 patients (UC: 450; CD: 676) were observed. (mean age of UC/CD 42.5/36.5 years; 47.6%/60.5% female). Among UC patients, IS was the most common (85.8%) index therapy, followed by aTNF (13.6%) and aI (0.7%). Respective numbers for CD patients were 77.7% (IS), 21.2% (aTNF), and 1.2% (aI). By 12 months, 55.7% of UC and 57.7% of CD patients discontinued their index therapy. Of the 990 patients followed for 24 months (UC: 395; CD: 595), 66.2%/67.8% discontinued index therapy. Of the 802 patients followed for 36 months (UC: 325; CD: 477), 73.1%/74.4% discontinued index therapy. Adjusting for baseline characteristics, aTNF was associated with later treatment discontinuation compared with IS (hazard ratio [HR]: 0.364, P<0.001) in UC patients. In CD patients, both aTNF and aI were associated with later treatment discontinuation compared with IS (aTNF HR: 0.562, P<0.001; aI HR: 0.187, P=0.018). Persistence with IBD treatment is far from ideal. As demonstrated in previous studies, IBD treatment discontinuation mainly results from poor effectiveness and/or safety concerns. The NP rate demonstrates the need for development of more effective and safe IBD therapies in an effort to support better real-world outcomes and treatment persistence.