(U) Drug Utilization of Biologic Therapy in Crohn's Disease and Ulcerative Colitis: A Population Based Danish Cohort Study 2015-2020

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 311

Presenting Author(s)

Kristoffer Jarlov Jensen
– Copenhagen Phase IV Unit, Frederiksberg, Denmark

Co-Author(s)

Camilla B. Jensen
– Copenhagen Phase IV Unit, Frederiksberg, Hovedstaden, Denmark
Christina Wennerström
– Nordic Medical Operations, Janssen Cilag AB, Sweden
Kari Stougaard Jacobsen
– Medical Affairs, Janssen-Cilag A/S, Denmark
Johan Burisch
– Gastrounit, medical division, Hvidovre hospital, Denmark
Janne Petersen
– Copenhagen Phase IV unit, Department of Clinical Pharmacology and Center for Clinical research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark, Denmark

Background: For patients with Crohn’s disease (CD) and Ulcerative Colitis (UC) several biologic treatments have become available.

Objectives: The aim of the present study was to characterize the drug utilization and switch patterns of the biologics in respect to treatment line.

Methods: Using Danish national registries, the nation-wide study included individuals diagnosed with CD or UC who were biologic-naïve when initiating treatment with Infliximab (IFX), Adalimumab (ADA), Vedolizumab (VDZ), Golimumab (GOL), or Ustekinumab (UST) during years 2015-2020. The hazard ratios (HR) of switching or discontinuing biologic were explored using Cox regression adjusted for health-related and socio-economic parameters at treatment initiation.

Results: Among 3,016 CD patients and 3,014 UC patients, IFX was used as first line biologic treatment in 86% (2,579) of CD patients and 89% (2,688) of UC patients. This was followed by ADA with 12% (354), VDZ with 2% (73) and UST with 0.3% (10) for CD patients, and ADA with 6% (186), VDZ with 3% (98) and GOL with 1% (40) for the UC patients. Compared to IFX as first-line treatment, initiators of ADA had a higher risk of discontinuation among CD patients (HR: 1.96 (95% confidence interval: 1.61; 2.38)) and among UC patients (2.15 (1.69; 2.74)), whereas initiators of VDZ had a lower risk of discontinuation among CD patients (HR: 0.58 (0.32; 1.04)) and among UC patients (0.48 (0.28; 0.84)). Analyses of GOL and UST were impaired due to few events.
In total, 43% (1,292) of CD patients and 43% (1,291) of UC patients started a second line biologic treatment, while 19% (587) of CD patients and 19% (564) of UC patients started a third line biologic treatment. Only 9% (273) of CD patients and 9% (277) of UC patients proceeded to fourth line biologic treatment. No difference in risk of switch in biologic treatment was observed comparing the first-line biologics.

Conclusions: More than 85% of CD and UC patients initiating biologic therapy had IFX as their first-line biologic treatment, which is recommended by the official treatment guidelines. The reason for deviation from treatment guidelines or switch in therapy should be explored in further studies as well as the higher incidence of treatment discontinuation for ADA as first-line treatment.