Cedars-Sinai Medical Center Los Angeles, CA, United States
Yanni Fan,1, Ling Zhang, 1, Rhonda Bohn, 2, Silvia Delgado-Aros, 3, Gil Melmed, MD4 1Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT; 2Bohn Epidemiology, Boston, MA; 3Boehringer Ingelheim Pharmaceuticals, Inc., Ingelheim am Rhein, Rheinland-Pfalz, Germany; 4Cedars-Sinai Medical Center, Los Angeles, CA
Introduction: Up to one third of patients with Crohn’s disease (CD) suffer from fistulae during their disease course, though population-based epidemiologic estimates have not been well characterized. Although biologics and antibiotics may be effective in some patients, surgical intervention is common due to frequent failure of medical therapy. We aimed to estimate the incidence rate and prevalence of fistulizing CD in the US, and describe treatment patterns among incident cases
Methods: We conducted a retrospective cohort study utilizing the Optum claims database . We identified individuals with ≥ 365-day continuous enrollment with an initial (index) diagnosis of fistula and a diagnosis of CD during the study period. Those without pre-index fistula were defined as incident cases. Crude and age- and sex-adjusted incidence rates and prevalence were estimated for the overall cohort and by calendar year and age. CD-related medications and surgeries were examined quarterly for one year post-index among incident cases. Time-to-first surgery was assessed by Kaplan-Meier method
Results: A total of 2733 incident and 5082 prevalent cases were identified (mean age 47 years [SD=19], 50% female). The crude incidence rate and prevalence for 2017-2019 were 7.8 per 100,000 person-years (95% confidence interval [CI]: 7.51, 8.10) and 25.17 per 100,000 persons (95% CI: 24.48, 25.87), respectively, with nearly no change after adjusting for age and sex. The incidence rate was generally stable from 2017 to 2019 but increased with age until a peak of 40-49 years, and was similar by sex. For prevalence estimates, we observed a similar age peak at 40-49 years, with no influence by sex. Treatments within the first year post-index were stable by quarter: 5-aminosaliciylates (11-13%), immunomodulators (16%), anti-tumor necrosis factor (TNF) therapy (34-35%), vedolizumab (6-7%), ustekinumab (7-9%), and any biologic (45-49%). Antibiotic and corticosteroid use in first quarter (Q1) were common (26% and 34%, respectively) with a decline to about 10% (antibiotics) or 20% (corticosteroids) in Q2, Q3 or Q4. Median time to the first surgery was 192 days (IQR: 29-506); 27% received a surgery in Q1
Discussion: Fistulae are an uncommon but highly morbid complication of CD in the US. About half of patients were prescribed biologic therapies within one year after an incident fistula diagnosis, with anti-TNF being the most widely prescribed class. About 30% and 50% of patients underwent surgical intervention within 3 or 6 months of diagnosis
Yanni Fan: Boehringer Ingelheim Pharmaceuticals, Inc. – Employee.
Ling Zhang: Boehringer Ingelheim Pharmaceuticals, Inc. – Employee.
Rhonda Bohn: Boehringer Ingelheim Pharmaceuticals, Inc. – Consultant.
Silvia Delgado-Aros: Boehringer Ingelheim Pharmaceuticals, Inc. – Employee.
Gil Melmed: AbbVie Inc. – Consultant. Arena Pharmaceuticals, Inc. – Consultant. Boehringer Ingelheim Pharmaceuticals, Inc. – Consultant. Bristol-Myers Squibb Company – Advisory Committee/Board Member, Consultant. Celgene Ltd – Advisory Committee/Board Member, Consultant. Entasis Therapeutics Holdings, Inc. – Consultant. Janssen Pharmaceuticals – Consultant. Medtronic Inc. – Consultant. Pfizer Inc. – Consultant, Grant/Research Support. Samsung Bioepis Co., Ltd. – Consultant. Shionogi Pharma Co., Ltd. – Advisory Committee/Board Member. Takeda Pharmaceutical Company Limited – Consultant. TECHLAB, Inc. – Consultant.
Yanni Fan,1, Ling Zhang, 1, Rhonda Bohn, 2, Silvia Delgado-Aros, 3, Gil Melmed, MD4. P1627 - Prevalence and Incidence of Fistulizing Crohn’s Disease and Associated Treatment Patterns in the United States, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.