Siegel Corey A, Sharma Dolly, Griffith Jenny, Doan Quynhchau, Xuan Si, Malter Lisa
Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Department of Health Economics and Outcomes Research, AbbVie, Inc, North Chicago, IL, USA.
Crohns Colitis 360. 2024 Aug 20;6(3):otae040. doi: 10.1093/crocol/otae040. eCollection 2024 Jul.
Patients with Crohn's disease (CD) or ulcerative colitis (UC) often cycle through conventional therapies (CT) with different mechanisms of action (MOA) before initiating advanced therapy (AT). We describe treatment patterns among patients with CD/UC.
Using Merative MarketScan Research databases, adult patients with CD/UC were identified from medical/pharmacy claims (2017-2021). Patients had ≥1 hospitalization or ≥2 outpatient visits (≥30 days apart within 1 year) for CD/UC. Two cohorts were established; cohort 1: Newly diagnosed patients (index date is the date of first diagnosis) and cohort 2: Patients initiating AT (index date is the date of first AT). First-line treatment patterns (cohort 1) and CT pathways before AT initiation (cohort 2) by the number of episodes (ie, adding a new therapy, switching to another therapy, or restarting the same therapy after ≥60 days) and MOA are reported.
Among newly diagnosed patients in cohort 1 (CD: = 1739; UC: = 2740), 14.4% (CD) and 5.9% (UC) of patients had any AT use during the follow-up period (mean: 2.3 years; ≥ 77% initiated corticosteroids). Among patients in cohort 2 (CD: = 2594; UC: = 2431), the mean number of CT episodes before AT initiation was 4.0 ± 4.3 (CD) and 5.9 ± 5.0 (UC). Among those with ≥1 corticosteroid episode (CD: 82.2%; UC: 91.5%), the mean number of episodes was 4.6 ± 4.3 (CD) and 6.3 ± 5.0 (UC). Overall, 13.3% (CD) and 23.7% (UC) of patients cycled through 3 MOAs before AT initiation.
Despite treatment recommendations, few newly diagnosed CD/UC patients initiated AT as their first treatment. Moreover, patients cycled through multiple CTs before initiating AT.
克罗恩病（CD）或溃疡性结肠炎（UC）患者在开始接受进阶治疗（AT）之前，常常会在具有不同作用机制（MOA）的传统疗法（CT）之间循环使用。我们描述了CD/UC患者的治疗模式。
利用默克医疗市场扫描研究数据库，从医疗/药房索赔记录中识别出成年CD/UC患者（2017 - 2021年）。患者因CD/UC有≥1次住院或≥2次门诊就诊（1年内间隔≥30天）。建立了两个队列；队列1：新诊断患者（索引日期为首次诊断日期），队列2：开始接受AT的患者（索引日期为首次接受AT的日期）。报告了按发作次数（即添加新疗法、换用另一种疗法或在≥60天后重新开始相同疗法）和作用机制划分的一线治疗模式（队列1）以及AT开始前的CT治疗路径（队列2）。
在队列1的新诊断患者中（CD：= 1739；UC：= 2740），14.4%（CD）和5.9%（UC）的患者在随访期间（平均：2.3年；≥77%开始使用皮质类固醇）使用了任何AT。在队列2的患者中（CD：= 2594；UC：= 2431），AT开始前CT发作的平均次数为4.0±4.3（CD）和5.9±5.0（UC）。在有≥1次皮质类固醇发作的患者中（CD：82.2%；UC：91.5%），发作的平均次数为4.6±4.3（CD）和6.3±5.0（UC）。总体而言，13.3%（CD）和23.7%（UC）的患者在AT开始前在3种作用机制之间循环使用。
尽管有治疗建议，但很少有新诊断的CD/UC患者将AT作为首次治疗。此外，患者在开始接受AT之前在多种CT之间循环使用。
