S0762 Nonbiologic Drug Use One Year Before and Two Years After Initiation of Ustekinumab or Adalimumab for Crohn's Disease Patients

Abstract

INTRODUCTION: The effect of biologic treatment on use of non-biologic drugs for treatment of Crohn’s disease (CD) symptoms may serve as a measure of treatment effectiveness. OBJECTIVE To describe nonbiologic outpatient pharmacy claim activity for CD patients 1-year before and 2-years after initiating ustekinumab (UST) or adalimumab (ADA). METHODS: Symphony Health data was used to identify adult patients with ≥2 CD diagnoses and ≥1 new (i.e., no claim for ≥1-year) outpatient pharmacy claim for UST or ADA (1st claim date = index) on and after 9/26/2016. Patients with facility-based drug claims, diagnoses for non-CD biologic indications, and those not meeting minimum claim activity requirements were excluded. One-year pre- and 2-year post-index outcomes were patients with ≥1 outpatient pharmacy claim for corticosteroid, immunosuppressant, GI anti-inflammatory, ciprofloxacin, metronidazole, antidiarrheal, antispasmodic, or opioid medications. Differences in pre- and post-index utilization were tested using a generalized estimating equation (GEE) model; between group pre-index differences were tested with chi-square. RESULTS: Average age for 935 UST and 2,827 ADA patients who met analysis criteria was similar (∼42 years; P = 0.6089) and 60.4% of UST patients were female vs 57.1% of ADA (P = 0.0703). The percentage of patients with ≥1 prior biologic in the outpatient claims was 52.1% for UST vs 8.3% for ADA. For UST, the percent of patients with ≥90 days exposure to corticosteroids declined from 30.7% in the pre-period to 22.2% in post-index year 1 (P < 0.0001) and to 17.3% post-index year 2 (P < 0.0001); for ≥30 days of opioids declined from 31.8% to 27.6% (P = 0.0484) to 22.5% (P < 0.0001). ADA showed similar trends; the percentage with ≥90 days exposure to corticosteroids declined from 16.9% to 14.5% (P = 0.0105) to 9.9% (P < 0.0001). The percentage with ≥30 days of opioids declined from 20.1% to 20.0% (P = 0.9470) to 16.6% (P = 0.0007). Results for additional pre to post-index medication use are included in Tables 1 and 2. CONCLUSION: While the populations of patients with claims for UST and ADA differed in prior biologic experience and likely in disease severity, both showed reductions in use of non-biologic drugs from pre to post-index periods and from year 1 to year 2 in a number of drug categories including corticosteroids and opioids. Future studies examining non-biologic drug use while controlling for baseline confounders are warranted to assess relative effectiveness of UST and ADA.Table 1Table 2