P502 Persistence of remission amongst patients with inflammatory bowel disease after adalimumab therapy is stopped: economic and clinical implications
x. Cortés*1, J. R. MOLÉS2, S. Fernández3, J. Clofent3, M. Moreno4, J. Rodriguez3, J. Primo3
1Hospital de Sagunto, Valencia, Spain, 2HOSPITAL DE SAGUNTO, VALENCIA, Spain, 3HOSPITAL DE SAGUNTO, Valencia, Spain, 4Hospital de sagunto, Valencia, Spain
Objective: The aim of this study is determine the persistence, clinic and economic effect of adalimumab (ADA) discontinuation in inflammatory bowel disease (IBD) with at least 6 months in sustained clinical remission (SCR).
We conducted an observational, and prospective study to assess the discontinuation of ADA treatment after achieving remission in IBD patients between September 2009 and October 2015. Eligible IBD patients were 18 years or older and in SCR on ADA by maintenance treatment of 40 mg every other week for a minimum of 6 months. We collected age, sex, indication, persistence (in years) of ADA treatment, discontinuation ADA period, and if there was an ADA relapse during the study period. In these patients, we simulated the cost of treatment with ADA using Humira® Spanish official prices. We determined the real cost of ADA treatment for each patient from individualised drug dispensations and correlated dates during the study period were collected from Outpatient Clinic Hospital Pharmacy software. The cost savings obtained during the patient ADA discontinuation was calculated using the ADA cost per day for each patient by the days of each patient in complete remission.
In total, 18 patients (72% women; age 36 ± 10 years; 15 Crohn’s disease [CD] and 3 ulcerative colitis [UC]) who discontinued ADA for at least 0.5 years of sustained clinical remission. Further, 53.3% of the patients presented ileal CD, and 46.7% colonic CD. Amongst the patients, 20% presented inflammatory CD; 46.7% stenosing CD; and 33.3% fistulising CD. More than 50% of the patients have perianal disease. In addition, 11% of the patients were active smokers. These patients were on ADA therapy for 2.1 ± 1.2 years towards achieving SCR and stopped ADA therapy. The persistence of these patients in SCR (discontinued ADA therapy) was 2.7 ± 1.0 years; range 1.3–4.1 years. Moreover, 12 (70.6%) patients had an IBD relapsed, and 9 restarted ADA therapy. In 8 relapsed patients, ADA-therapy-sustained complete remission was achieved again. Total associated ADA costs of patient included during the first episode of ADA therapy was 458.234 €, with an ADA patient daily cost of 38.1 ± 12.6 €. The implementation of the strategy of ADA discontinuation in IBD patients in SCR for at least 6 months produced a cost savings of 617.817 € thorough the study period, with an ADA cost savings per patient daily of 36.342 ± 15.012 €.
Discontinuation ADA treatment in IBD patients in SCR for at least 6 months could make treatment more cost-effective and allow gastroenterologists to treat more patients with a fixed budget.