P034 Rates of Anti-TNF Drug Persistence in Patients with Crohn’s Disease

P034  Rates of Anti-TNF Drug Persistence in Patients with Crohn’s Disease

 

Williams Ted1, Low Robert2, Pop Anca2, Polson Michael1
1 Magellan Health, Middletown, United States, 2 UCB Pharma, Atlanta, United States

BACKGROUND: Crohn’s disease (CD) is an inflammatory bowel disease with steadily increasing incidence over the past several decades. Three anti-tumor necrosis factor (TNF) agents (infliximab, adalimumab, and certolizumab pegol) have demonstrated efficacy in treatment of patients with moderate to severe CD who inadequately respond to treatment with corticosteroids, thiopurines, and/or methotrexate.
The aim of this study was to determine differences in persistence for 2 sub-populations of patients with CD treated with anti-TNF agents: anti-TNF naïve patients, and patients switching from one anti-TNF agent to another.

METHODS: The study population for this retrospective analysis was drawn from real world administrative claims data for patients enrolled in Medicare or commercial regional health plans from 1/1/2010 to 9/30/2018 with a diagnosis for CD and at least one pharmacy or medical claim for an anti-TNF agent used in the treatment of CD. Patients with 12 months of baseline data with no anti-TNF treatment were considered anti-TNF naïve and assigned an index date of the first medical or pharmacy claim for an anti-TNF agent. Patients with claims for 2 or more anti-TNF agents during the claim’s evaluation window were considered anti-TNF experienced patients and assigned an index date of the date of service for the first medical or pharmacy claim for a different anti-TNF agent than previously observed. Both sub-populations were followed for 12 months beginning on the index date. Study groups were assigned based on the anti-TNF agent used on the index date. A composite outcome of persistence was defined as patients without any of the following during the 12-month follow up period: anti-TNF agent change, anti-TNF discontinuation, escalation of anti-TNF dose, or reduction of anti-TNF dose. Logistic regression was used to identify any associations between baseline characteristics and composite persistence, as well as to compare treatments using certolizumab pegol as the reference value.

RESULTS: For the 4,265 anti-TNF naïve patients, the initial therapy consisted of 54% infliximab, 43% adalimumab, and 3% certolizumab pegol. Composite persistence was 67% for infliximab, 57% for adalimumab, and 52% for certolizumab pegol (p<.0001). After adjusting for other model covariates, patients treated with infliximab had a significant increase in composite persistence (p<.0001), while differences in composite persistence were not significantly different for adalimumab.
For the 880 patients switching anti-TNF agent, 41% switched to infliximab, 36% to adalimumab, 20% to certolizumab pegol, and 3% to other agents. The composite persistence in patients switching agents was lower than that observed in treatment-naïve patients. Composite persistence was not significantly different between the groups (adalimumab 53%, certolizumab pegol 50%, infliximab 45%, other agents 42%, p=0.1581). After adjusting for other model covariates, patients switching to adalimumab had an increase in persistence (p=0.0423). Differences in persistence were not significant when switching to infliximab.

CONCLUSION(S): Composite persistence, as defined by stable and continuing anti-TNF therapy, was low after 1 year across all sub-populations. No single agent provided consistently higher composite persistence in both treatment-naïve and treatment experienced patients.

Funding: UCB Pharma