Treatment Patterns in Newly Diagnosed Patients with Crohn’s Disease Who Received Biologics Following Diagnosis: A Nationwide, Retrospective, Longitudinal, Observational Study Using a Medical Claims Database in Japan

Abstract

<b><i>Introduction:</i></b> Crohn’s disease (CD) is a chronic inflammatory condition affecting any part of the gastrointestinal tract. Current therapies involve pharmacological efforts to dampen inflammation. Biologics are recommended for patients with steroid-dependent or steroid-refractory disease; however, little is known about current biologic use in real-world settings in Japan. <b><i>Methods:</i></b> This observational, longitudinal, cohort study utilized the Japan Medical Data Center (JMDC) database to analyze claims data of patients who were prescribed ≥1 biologic (adalimumab, infliximab, or ustekinumab) following a new CD diagnosis made between January 2009 and January 2019. We primarily assessed the type of first-line treatment prescribed within 6 months of a patient’s first CD diagnosis. <b><i>Results:</i></b> Of the 1,346 eligible patients, the most common prescriptions were 5-aminosalicylic acid (5-ASA) monotherapy (26.8%), 5-ASA plus biologic combination (26.3%), and biologic monotherapy (12.9%). First-line biologics were prescribed within 6 months of initial CD diagnosis in 61.1% of patients, either alone or in combination with other therapies. As an individual first-line treatment, the proportion of patients receiving prescriptions of infliximab was high (66.3%) and steroids, low (1.3%). Patients who had a procedure to inspect the small intestine, such as endoscopy (<i>n</i> = 508), were mostly treated with a nonbiologic therapy (74.8%), whereas those who had not (<i>n</i> = 838), mostly received biologics (alone or in combination, 82.8%) as a first-line treatment. <b><i>Conclusions:</i></b> In this study, we discovered the typical treatment pattern of patients with CD who received biologics and are registered in the JMDC database in Japan. Biologics were commonly used in the early phase of CD treatment. Treatment with traditional approaches such as steroids and nutritional therapy with evaluation for small intestine lesions, before turning to the use of biologics, may be prudent for achieving optimal outcomes.

Dietary Perceptions among Patients with Crohn’s Disease in Clinical Remission: Comparison with an Era Preceding the Availability of Biologic Therapy

“…It subsequently gained approval for use in CD treatment under Japanese National Health Insurance coverage in 2002 for induction and in 2007 for maintenance. A recent study using a medical claims database in Japan reported that approximately one-third of CD patients were introduced to biologics within 6 months of a new diagnosis [11]. Another report from a multicenter cohort in Japan showed that the percentage of patients who received biologics in IBD expert facilities was approximately 80%, which was significantly higher than that in community hospitals [12].…”