Market share and costs of biologic therapies for inflammatory bowel disease in the USA

Yu, Helen; MacIsaac, Donna; Wong, Jessie J.; Sellers, Zachary M.; Wren, Anava A.; Bensen, Rachel; Kin, Cindy; Park, KT

doi:10.1111/apt.14430

Cited by 151 publications

(117 citation statements)

References 22 publications

(38 reference statements)

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…Response to the available agents is observed only in portions of patients [2][3][4] and, additionally, patients may lose response over time [5]. Moreover, there is evidence indicating that the probability of response to a subsequent treatment is lower, if previous therapies have failed [6], and health care systems may be encumbered with costs for ineffective therapies [7].…”

Section: Introductionmentioning

confidence: 99%

Baseline levels of dynamic CD4+ T cell adhesion to MAdCAM-1 correlate with clinical response to vedolizumab treatment in ulcerative colitis: a cohort study

et al. 2020

View full text Add to dashboard Cite

Background: While the number of therapeutic options for treating inflammatory bowel diseases (IBD) is increasing, evidence for rational treatment decisions is scarce in many cases. In particular, appropriate biomarkers to predict the response to the anti-α4β7 integrin antibody vedolizumab are currently lacking. Methods:We performed a cohort study with 21 patients suffering from ulcerative colitis (UC), in which first-time treatment with vedolizumab was initiated. CD4 + T cells were isolated from the peripheral blood and dynamic adhesion to recombinant mucosal vascular addressin cell adhesion molecule (MAdCAM-)1 in vitro as well as the effect of vedolizumab on such adhesion in vitro was determined. The expression of α4β1 integrin on peripheral blood CD4 + T cells was quantified by flow cytometry. Electronic patient records were reviewed to determine clinical response to vedolizumab.Results: Dynamic adhesion of peripheral blood CD4 + T cells to MAdCAM-1 and the reduction of adhesion following vedolizumab treatment in vitro were higher and the change in α4β1 expression on CD4 + T cells was different in vedolizumab responders and non-responders. Responders could be identified with high specificity and positive-predictive value. Conclusions: Determining dynamic adhesion of CD4 + T cells to MAdCAM-1 and the in vitro response to vedolizumab before treatment initiation or dynamic integrin regulation in the early course of treatment seem to be promising tools to predict the clinical response to vedolizumab therapy. Larger prospective studies are warranted.

show abstract

Section: Introductionmentioning

confidence: 99%

Baseline levels of dynamic CD4+ T cell adhesion to MAdCAM-1 correlate with clinical response to vedolizumab treatment in ulcerative colitis: a cohort study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In this cohort as in most IBD centres worldwide, the majority of patients were of relatively young age and would therefore potentially require biologics, immunomodulators and/or 5‐ASA therapies for decades post‐diagnosis. Drug costs are therefore a huge and growing impost to health payers which cannot be ignored by clinicians and should be mitigated wherever possible . Data assessing clinical outcomes following discontinuation of 5‐ASA therapy with or without concomitant immunomodulating therapy are limited.…”

Section: Discussionmentioning

confidence: 99%

Aminosalicylate withdrawal following escalation to immunomodulators or biologics in ulcerative colitis: cost saving, convenient and does not compromise efficacy

2020

View full text Add to dashboard Cite

Background Aminosalicylates are widely used in ulcerative colitis (UC) and often continued despite treatment escalation, perhaps given a lack of evidence or consensus guiding dose reduction or cessation. The aim was to compare long‐term outcomes in patients who escalated treatment and either continued or discontinued aminosalicylate therapy. Methods Consecutive patients diagnosed with UC ≥1 year prior to escalation to immunomodulator or biologic therapy while concurrently taking aminosalicylates, were compared based on discontinuation versus continuation of aminosalicylates once clinical remission was achieved (denoted as baseline). The primary endpoint was time (from baseline) to treatment failure, defined as requiring steroids, resumption of aminosalicylates or surgery. Successful discontinuation was achieved if no treatment failure occurred throughout follow‐up. The resultant cost savings per patient‐year gleaned by aminosalicylate discontinuation were calculated. Results Of 128 patients meeting inclusion criteria, 71 discontinued and 57 continued aminosalicylates post‐escalation. Median disease duration was 8.2 and 8.7 years (P = .2), time from escalation to baseline 1.8 and 2.9 years (P = .1) respectively. Post‐escalation, median time on immunomodulator was longer, yet no difference in time on biologics was observed, with successful aminosalicylate discontinuation (versus unsuccessful) (2.9 vs 1.2 years (P = .03), 0.4 vs 0.6 years (P = .8) respectively). Kaplan‐Meier survival analysis demonstrated no difference in proportion of treatment failure in the groups post‐baseline (Breslow test, P = .4), yet aminosalicylate discontinuation yielded cost savings of $AUD 2000 per patient‐year. Conclusions These real‐world data support discontinuation of aminosalicylates after achieving remission with either immunomodulator or biologic therapy in UC, at minimal risk of relapse yet enabling significant reductions in cost and tablet burden.

show abstract

“…It is possible that clinicians preferentially selected patients with milder IBD severity when referring patients for bariatric surgery. There is some indication of this in the data, as 30% of patients were on no medications for IBD and only 10% were on biologics, which is considerably lower than the market share of biologics in the US in the last 10 years [22]. Moreover, type of surgery may be an important consideration.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Bariatric Surgery Is a Safe and Effective Option for Patients with Inflammatory Bowel Diseases: A Case Series and Systematic Review of the Literature

et al. 2018

View full text Add to dashboard Cite

Background: Questions remain regarding both the safety and efficacy of bariatric surgery in patients with inflammatory bowel diseases (IBD), including the effects of bariatric surgery on the course of disease. We report a case series from a tertiary care IBD referral center and review the existing literature regarding the safety and efficacy of bariatric surgery in IBD patients. Objectives: Examine the safety and efficacy of bariatric surgery in IBD patients. Explore possible effects of weight loss on postoperative IBD course. Method: We performed a retrospective review of patients at our center undergoing bariatric surgery with a concurrent IBD diagnosis, collecting baseline characteristics, surgery type, and postoperative course (including IBD outcomes and weight loss). Data from these patients were combined with available data from the existing literature to calculate standardized means with standard error, variance, and confidence intervals (CI). Results: Data from 13 patients who had undergone bariatric surgery at our facility were combined with data from 8 other studies to create a study population of 101 patients. Of these, 61 had Crohn’s disease, 37 ulcerative colitis, and 3 IBD-unspecified, with a mean preoperative BMI of 44.2 (95% CI 42.9–45.7). Following surgery, a mean excess weight loss of 68.4% was demonstrated (95% CI, 65.7–71.2). Of the 101 patients, 22 experienced early and 20 experienced late postoperative complications. Postoperatively, 10 patients experienced a flare of IBD, 20 remained in remission, and 7 patients were able to discontinue immunosuppressive therapy. Conclusions: Based on available studies, bariatric surgery appears to be both an effective and safe option for weight loss in patients with IBD.

show abstract

Market share and costs of biologic therapies for inflammatory bowel disease in the USA

Abstract: The vast majority of costs allocated to out-patient IBD medications in the USA is attributed to increasing use of biologic therapies despite the relative minority of biologic-taking patients.

Cited by 151 publications

References 22 publications

Baseline levels of dynamic CD4+ T cell adhesion to MAdCAM-1 correlate with clinical response to vedolizumab treatment in ulcerative colitis: a cohort study

Baseline levels of dynamic CD4+ T cell adhesion to MAdCAM-1 correlate with clinical response to vedolizumab treatment in ulcerative colitis: a cohort study

Aminosalicylate withdrawal following escalation to immunomodulators or biologics in ulcerative colitis: cost saving, convenient and does not compromise efficacy

Bariatric Surgery Is a Safe and Effective Option for Patients with Inflammatory Bowel Diseases: A Case Series and Systematic Review of the Literature

Contact Info

Product

Resources

About