Regional differences in anti-TNF-α therapy and surgery in the treatment of inflammatory bowel disease patients: a Norwegian nationwide cohort study

Lirhus, Sandre Svatun; Høivik, Marte Lie; Moum, Bjørn; Melberg, Hans Olav

doi:10.1080/00365521.2018.1495258

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…This finding was somewhat surprising as it appears to contradict guideline recommendations, which recommend that biologics are used in steroid-dependent/refractory disease [1][2][3]. The rate of first-line biologic prescribing was also higher than has been reported in studies from other countries and regions [17][18][19][20][21][22][23], although this may be associated with the population selected for this study in which only patients who received biologics as part of their treatment course were included in the analysis. When these data were analyzed by whether intestinal inspection had been performed, patients who had undergone intestinal inspection in the 12 months prior to biologic introduction had a numerically lower rate of first-line biologic use (either as monotherapy or in combination with other drugs) and a statistically longer time from first CD diagnosis to biologic introduction (mean of 9.4 vs 0.9 months, respectively), compared with patients who had not undergone these investigational procedures.…”

Section: Discussioncontrasting

confidence: 56%

Imaging and treatment patterns in newly-diagnosed patients with Crohn’s disease: analysis of a Japanese claims database

Hirai

Uda

Ota

et al. 2019

Preprint

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Background: The biologics adalimumab, infliximab, and ustekinumab are approved to treat Crohn’s disease (CD) in Japan; they are recommended to induce/maintain remission in steroid-dependent/steroid-refractory CD. However, little is known about biologic use in real-world clinical practice, particularly in the initial treatment stage following endoscopic/radiographic diagnosis (intestinal inspection). Methods: This observational, retrospective, longitudinal cohort study assessed patients in the Japan Medical Data Center claims database who were diagnosed with CD from 2009–2019, and prescribed ≥ 1 biologic (adalimumab, infliximab, ustekinumab). Primary outcomes were type of first-line treatment prescribed on/within 6 months of first CD diagnosis, and time from first diagnosis to biologic introduction. Results: The study included 1346 patients with newly-diagnosed CD who were prescribed a biologic (adalimumab, n = 434; infliximab, n = 892; ustekinumab, n = 20). Most common first-line treatments were 5-aminosalicylic acid (5-ASA) monotherapy (26.8%), 5-ASA plus biologic (26.3%), and biologic monotherapy (12.9%). First-line steroids (monotherapy/in combination) were prescribed in 10.8% of patients. The first-line biologic prescription rate was lower in patients who had undergone intestinal inspection within 12 months before biologic introduction versus those who had not (5.3% vs 17.4% in monotherapy; 19.9% vs 65.4% in combination with other agents). Mean time from diagnosis to first biologic prescription was 4.1 months. Conclusions: The study demonstrated high use of biologics (particularly infliximab) and low use of steroids in initial treatment of Japanese patients with newly-diagnosed CD who received biologics during their treatment course. Biologic prescription was more common in patients who had not undergone prior intestinal inspection.

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Section: Discussioncontrasting

confidence: 56%

Imaging and treatment patterns in newly-diagnosed patients with Crohn’s disease: analysis of a Japanese claims database

Hirai

Uda

Ota

et al. 2019

Preprint

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“…Yu et al observed a far greater increase in the use of biologic treatment in CD (from 21.8% to 43.8%) in a recent study performed in the United States (US) between 2007 and 2015 [ 20 ]. Regarding western European studies, a population-based study in Denmark showed that 23.5% of CD patients were receiving biological treatment in 2012 [ 11 ]; in Norway, the use of anti-TNF in CD patients ranged from 20.9% to 31.4% in 2012 [ 21 ]; and a French study in 2014 reported rates of anti-TNF use of 33.8% in monotherapy, and 18.3% in combination with a non-biological immunosuppressive treatment [ 22 ]. Eastern European figures were much lower; for example, a Hungarian population-based study between 2011 and 2013 reported that only 8.5% of CD patients were receiving biological treatment [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Time Trends of Crohn’s Disease in Catalonia from 2011 to 2017. Increasing Use of Biologics Correlates with a Reduced Need for Surgery

Brunet

Vela

Melcarne³

et al. 2020

JCM

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Background and Aims: Data from clinical trials suggest that biological drugs may improve the outcomes in Crohn’s disease (CD) by reducing the need for surgery or hospitalization. The aim of this study is to evaluate the time-trends of the use of biological drugs and other treatments for CD, and its relationship with outcomes in Catalonia. Materials and Methods: All patients with CD included in the Catalan Health Surveillance System (containing data on a population of more than 7.5 million) from 2011 to 2017 were identified. The exposures to different treatments for inflammatory bowel disease were retrieved from electronic invoicing records. Results: Between 2011 and 2017, the use of salicylates, corticosteroids and immunosuppressive treatment fell from 28.8% to 17.1%, 15.8% to 13.7%, and 32.9% to 29.6%, respectively (p < 0.001). Biological treatment use rose from 15.0% to 18.7% (p < 0.001). Ostomy rates per 1000 patients/year fell from 13.2 in 2011 to 9.8 in 2017 (p = 0.003), and surgical resection rates from 24.1 to 18.0 (p < 0.001). The rate of CD-related hospitalizations per 1000 patients/year also fell, from 92.7 to 72.2 (p < 0.001). Conclusions: Biological drug use rose from 15.0% to 18.7% between 2011 and 2017. During this period, we observed an improvement in the outcomes of CD patients.

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“…It is known that anti-TNFα use in UC patients differs between the four health regions in Norway. 25 The hypothetical association between the physicians’ preference for a particular 5-ASA preparation and the clinical threshold for starting additional anti-inflammatory medication was adjusted for at a regional level by analyzing the persistence of oral 5-ASA preparations within each health region.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with the persistence of oral 5-aminosalicylic acid monotherapy in ulcerative colitis: a nationwide Norwegian cohort study

Fossmark

Olaisen

Martinsen

et al. 2021

Therap Adv Gastroenterol

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Background: Oral 5-aminosalicylic acid (5-ASA) is the mainstay treatment of ulcerative colitis (UC) and therapy with oral 5-ASA is associated with beneficial outcomes. We have examined factors associated with the persistence of oral 5-ASA treatment in a national cohort of UC patients. Methods: Patients with newly diagnosed UC from 2010 to 2014 using oral 5-ASA monotherapy were identified by combining data from the Norwegian Patient Registry and the Norwegian Prescription Database. The median follow-up time was 1029 days. Drug persistence was defined as duration of oral 5-ASA preparation as monotherapy. Non-persistence of a oral 5-ASA preparation as monotherapy was defined as stopping oral 5-ASA, initiation of any further anti-inflammatory treatment including a course of glucocorticoids and a change to another oral 5-ASA preparation. Drug persistence was analyzed using the Kaplan–Meier method and influence of covariates on drug persistence was analyzed with the Cox proportional hazard model. Results: A total of 3421 patients were identified. The overall median 5-ASA drug persistence was 179 days. In univariate analyses, persistence was associated with preparation type and high-dose treatment, while oral glucocorticoid use or hospitalization around the start of oral 5-ASA were associated with shorter 5-ASA persistence. In multivariate analyses, oral glucocorticoids [HR 1.67 (1.54–1.80), p < 0.005] and hospitalization around start of 5-ASA [HR 1.23 (1.14–1.34), p < 0.005] were associated with non-persistence, whereas high dose (⩾3 g/day) 5-ASA was associated with longer persistence [HR 0.68 (0.65–0.71), p < 0.005]. Conclusion: High-dose treatment with oral 5-ASA was associated with longer persistence of oral 5-ASA monotherapy, whereas the presence of factors indicating more severe disease around initiation of 5-ASA monotherapy was associated with a shorter persistence.

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Regional differences in anti-TNF-α therapy and surgery in the treatment of inflammatory bowel disease patients: a Norwegian nationwide cohort study

Abstract: Cumulative incidence of anti-TNF exposure and surgery varied significantly across Norway's health regions during the three first years after IBD diagnosis.

Cited by 10 publications

References 25 publications

Imaging and treatment patterns in newly-diagnosed patients with Crohn’s disease: analysis of a Japanese claims database

Imaging and treatment patterns in newly-diagnosed patients with Crohn’s disease: analysis of a Japanese claims database

Time Trends of Crohn’s Disease in Catalonia from 2011 to 2017. Increasing Use of Biologics Correlates with a Reduced Need for Surgery

Factors associated with the persistence of oral 5-aminosalicylic acid monotherapy in ulcerative colitis: a nationwide Norwegian cohort study

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