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DOP017 Patterns of anti-TNF use and associated treatment outcomes in inflammatory bowel disease patients: results from an analysis of Dutch health insurance claims data

Bots S.*1, Hoekman D.1,2, Benninga M.2, Ponsioen C.1, Smeets H.3, D'Haens G.1, Löwenberg M.1

1Academic Medical Center (AMC), Department of Gastroenterology and Hepatology, Amsterdam, Netherlands 2Academic Medical Center (AMC), Department of Pediatric Gastroenterology and Nutrition, Amsterdam, Netherlands 3Achmea Health Insurance, Amersfoort, Netherlands

Background

Patterns of anti-TNF use, associated treatment outcomes and drug costs have never been investigated in a large, real-life population of IBD patients.

Methods

Health insurance claims data from 22,082 Dutch IBD patients were provided by Achmea Healthcare. Patients starting with anti-TNF treatment from January 2008 till December 2014 were studied. The primary analysis was time to anti-TNF discontinuation. Furthermore, time to anti-TNF treatment intensification, corticosteroid free survival and time to hospitalization were analyzed, as well as treatment regimens.

Results

The proportion of infliximab (n=855) and adalimumab starters (n=1,199) who received intensified treatment increased over time (infliximab at 3 vs. 24 months: 22.2% vs. 33.6%, p=0.01; adalimumab at 3 vs. 24 months: 10.5% vs. 19.3%, p<0.001). Median time to anti-TNF discontinuation was 600 days (IQR 156–1693). Cessation of anti-TNF treatment was less common in Crohn's disease patients (HR 0.79, p=0.001) and in patients receiving intensified treatment regimens (HR 0.62, p=0.001). Immunomodulator use was not related to longer drug survival (HR 0.99, p=0.617), but was significantly associated with longer time to corticosteroid use (HR 0.80, p=0.048). Hospitalization was significantly more common in Crohn's disease patients (HR 1.49, p=0.011). Corticosteroid use was significantly lower in Crohn's disease patients (HR 0.57, p<0.001)and in patients using infliximab (HR 0.55, p<0.001).

Figure 1. The distribution of infliximab intervals over time.

Figure 2. The distribution of adalimumab intervals over time.

Figure 3. Kaplan-Meier curve of time to anti-TNF treatment discontinuation in Crohn's disease vs. ulcerative colitis patients.

Figure 4. Kaplan-Meier curve of time to corticosteroid use in patients on monotherapy vs. combinationtherapy.

Conclusion

Discontinuation of anti-TNF therapy occurred earlier than previously reported and was associated with ulcerative colitis and non-intensified anti-TNF treatment regimens. Immunomodulator use at the start of anti-TNF treatment was associated with longer time to corticosteroid use, but not with longer drug survival.