TEMPORAL TRENDS IN PHARMACEUTICAL USE FOR THE TREATMENT OF ULCERATIVE COLITIS

Abstract

Purpose: To investigate the temporal trends in the percentage of ulcerative colitis (UC) patients using 5-aminosalicylic acid (5-ASA), corticosteroids, antibiotics, and immunosuppressants alone or in combination for the treatment of UC. Methods: The data source was medical and pharmaceutical claims of a health plan, which has over 7 million members within 25 states (Ingenix Lab/Rx Database™). Among members with at least two continuous years in the health plan, UC patients were identified by a medical claim with a diagnosis code of ICD-9-CM 556 in at least two ambulatory visits or one hospitalization. Four categories of pharmaceutical therapies (5-ASA, corticosteroids, antibiotics, and immunosuppressants) for UC were identified by searching for generic pharmaceutical names within the Drug Topics Red Book. There were 1,933 national drug codes identified. The percentage of UC patients using each pharmaceutical category in a month was calculated by dividing the number of patients with a specific therapy by the number of patients with any therapy. The percentage of UC patients using 5-ASA in combination with another therapy was calculated by dividing the number of patients with another therapy contemporaneously prescribed with 5-ASA by the number of patients with a 5-ASA prescription. Results: During 3.5 years of observation, there were 12,061 UC patients, corresponding to a prevalence of 236 per 100,000 persons within the plan. The demographic profile of the UC population was 53% males and 47% females; 24% less than 35 years of age, 64% ages 35–64, and 12% age 65 and over. The predominant pharmaceutical therapy was 5-ASA, which was used by more than 75% of UC patients. Between January 2000 and June 2003, the percent of patients using immunosuppressants increased from 14% to 19% (p <0.05), antibiotic use decreased from 14% to 10% (p <0.05), and using corticosteroids remained constant near 20%. The percentage of patients using 5-ASA concomitantly with corticosteroids, immunosuppressants, or antibiotics remained constant at 9%. Conclusions: The use of 5-ASA continues to be the leading treatment of UC. Although the use of alternative agents was variable over 3.5 years, the concomitant use of these agents with 5-ASA was minimal and unchanged. These results demonstrate that monotherapy with 5-ASA is most commonly utilized to treat UC.