Sa1737 - Cost Per Responder and Cost Per Remitter Analysis of Ustekinumab Compared to Adalimumab Among Patients with Moderate-to-Severe Crohn's Disease in the United States: An Analysis of the Failure to Conventional Therapy Subgroup

Abstract Objectives The objective of this study was to assess current treatment patterns of pediatric ulcerative colitis (UC) and Crohn’s disease (CD) patients, using data in the ImproveCareNow (ICN) registry. Methods Pediatric (2–17 years) patients in the United States who were newly diagnosed with UC or CD between June 1, 2013-December 31, 2019, who had their first recorded ICN visit within 6 months of diagnosis and who were actively followed for at least 12 months (± 90 days) were included in this study. Descriptive statistics of baseline patient demographics were summarized for the overall IBD patient population and separately for UC and CD. Treatment patterns (including use of corticosteroids, 5-aminosalicylic acid (5-ASA), 6-mercaptopurine/azathioprine (6-MP/AZA), methotrexate, tumor necrosis factor inhibitors (TNFi) [adalimumab, infliximab, certolizumab, golimumab, and their biosimilars], ustekinumab, vedolizumab, and other medications [natalizumab and tofacitinib]) were assessed at the initial baseline visit, and at 1-year and 3-year time points. Results A total of 6,504 pediatric IBD patients (UC=1,784; CD=4,720) were included in this study. Patients had a mean age at diagnosis of 13.0 years (UC=13.2; CD=12.9), 57.1% were male (UC=49.6%; CD=60.0%), and 81.0% were White (UC=81.2%; CD=81.0%) (Table 1). At the initial ICN visit, 46.4% of UC patients were prescribed a corticosteroid, while 19.8% received a 5-ASA, 12.6% received a TNFi, 10.4% received a 6-MP/AZA, 3.0% received methotrexate, and 0.3% received vedolizumab. At the initial visit, 40.2% of CD patients were prescribed a corticosteroid, while 29.1% received a TNFi, 18.5% received a 6-MP/AZA, 12.4% received methotrexate, and 3.3% received a 5-ASA. At the 1-year and 3-year time points, rates of 5-ASA and corticosteroid use decreased among UC patients; however, rates of 6-MP/AZA, methotrexate, and TNFi increased (Table 2). Similarly, at the 1-year and 3-year time points, rates of corticosteroids among CD patients decreased; however, rates of methotrexate and TNFi increased (Table 2). There was also an increase in use of ustekinumab and vedolizumab over time among UC and CD patients. Conclusion These results highlight the current treatment patterns of pediatric UC and CD patients in the United States. At the initial ICN visit, the 46% of UC and 40% of CD patients were receiving corticosteroids, however, at 1-year and 3-years after initial visit, over 30% of UC patients and over 60% of CD patients were receiving TNF inhibitors with considerably reduced corticosteroid use.

Download Full-text

Prevalence of Fistulizing Crohn’s Disease in the United States: Estimate From a Systematic Literature Review Attempt and Population-Based Database Analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz056 ◽

2019 ◽

Vol 25 (11) ◽

pp. 1773-1779 ◽

Cited By ~ 8

Author(s):

David A Schwartz ◽

Ignacio Tagarro ◽

Mary Carmen Díez ◽

William J Sandborn

Keyword(s):

United States ◽

Health Care ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Literature Review ◽

Systematic Literature Review ◽

The United States ◽

Population Based ◽

Number Of Patients ◽

Reported Data

Abstract Background Fistulas may arise as a relevant complication of Crohn’s disease (CD). Despite their clinical significance and the substantial burden imposed on patients, limited data are available on the epidemiology of fistulizing CD in the United States. Methods A systematic literature review was conducted to identify data published between 1970 and 2017 on the epidemiology of fistulas in patients with CD, with the aim to estimate the number of prevalent cases in the United States. Retrieved titles and abstracts were screened by 2 independent researchers for inclusion criteria (US population-based studies reporting data on the epidemiology of fistulizing CD). To validate the literature-based estimate, data from a US claims database (Truven Health MarketScan database) were analyzed. This database has broad geographic coverage, with health care data for >60 million patients during the period of the analysis. Results The literature search retrieved 7 articles for full-text review, and only 1 met the criteria for inclusion. This study described the cumulative incidence of fistulas in a CD population from Minnesota over 20 years. From the reported data, the estimated number of prevalent cases with fistulizing CD in the United States was ~76,600 in 2017 (~52,900 anal, ~7400 rectovaginal, ~2300 enterocutaneous, and ~14,100 internal). Analysis from the US health care database resulted in an estimated number of ~75,700 patients, confirming the robustness of the original estimate from the literature. Conclusions Based on 2 separate analyses, the estimated number of patients with fistulizing CD in the United States is ~77,000 patients.

Download Full-text