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DOP060 Real-world treatment pathway visualizations show low use of biologic therapies in Crohn's disease and ulcerative colitis in the United States

Siegel C.*1, Yang F.2, Eslava S.2, Cai J.2

1Dartmouth-Hitchcock Medical Center, Lebanon, United States 2Celgene Corporation, Summit, United States


Treatment for Crohn's disease (CD) and ulcerative colitis (UC) has advanced over the past 20 years with the introduction of biologics. Despite their availability, patients (pts) may not be optimally managed. The aim of this study is to visualize CD and UC treatment pathways to gain insight into real-world treatment patterns.


The Truven Health MarketScan database was used to assess treatment pathways in a large US insured population. Included pts were those who had ≥2 consecutive health claims for CD (ICD-9-CM: 555x; ICD-10-CM: K50x) or UC (ICD-9-CM: 556x; ICD-10-CM: K51x) ≥30 days apart, with ≥1 occurrence of NDC/HCPCS codes for CD or UC medications from January 1, 2008-March 31, 2016, and a minimum continuous enrolment criterion of 12 months pre-index and 24 months post-index date. The index date is the date of the first diagnosis (CD or UC) in the database for each pt. In the CD analysis, pts' UC diagnoses were excluded, and vice versa. Sankey diagrams, used to visualize treatment pathways, depicted unique sequences of IBD treatments and quantified pts across different pathways. Treatment pathways were defined by the introduction of discreet agents in the patient's treatment course. A monotherapy (monotx) pathway was defined as the use of the same single agent, once or repeatedly, throughout the treatment course.


16,260 CD and 28,120 UC pts were included. Corticosteroid (CS) monotx was the most common first-line agent (42%) and treatment pathway (26%) for CD pts. The CS monotx pathway represents nearly two-thirds of pts initially using CS; 63% of these CD pts had ≥2 steroid cycles; 108 had ≥10 cycles in the observed period. 5-ASA monotx was the second most common treatment pathway for CD (12%) and most common for UC (24%). CS monotx was the second most common pathway for UC pts (16%). Pts using 5-ASAs as initial treatment had a longer time to biologic initiation vs pts using other first-line therapies. Overall, biologic pathways were relatively rare (CD pts: 19%; UC pts: 6%), and even fewer pathways use biologics combined with other agents (CD pts: 15%; UC pts: 5%). The most common biologic pathway in these populations was adalimumab (ADA) monotx (CD pts: 0.5%; UC pts: 0.04%), followed by infliximab monotx (CD pts: 0.3%) or 5-ASA switching to ADA (UC pts: 0.03%).


This real-world data analysis identified unique treatment pathways visualized through Sankey diagrams. Our findings indicate few pts are treated with biologics; of those using biologics, few receive combination therapy, despite support for this approach. These findings suggest current treatment guidelines and disease management recommendations may not be uniformly followed in the real-world setting.