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P710 The use of first-line biologics in patients with Crohn’s disease in Norway from 2011 to 2016

K. Anisdahl*1,2, S. Lirhus3, A. Medhus1, L. Buer1,2, H. O. Melberg3, B. Moum1,2, M. Lie Høivik1

1Oslo University Hospital, Department of Gastroenterology, Oslo, Norway, 2University of Oslo, Institute of Clinical Medicine, Oslo, Norway, 3University of Oslo, Institute of Health and Society, Oslo, Norway

Background

Treatment of Crohn’s disease (CD) is preference based and might also be affected by drug costs. In Norway, biosimilar infliximab entered the market in 2014 at a reduced cost of 40% compared with the original product. We have previously shown an increase in the use of biologics for inflammatory bowel disease (IBD) between 2011 and 2014. In the present study, we aimed to assess whether there was a change over time in the proportion of patients receiving biologics between 2011 and 2016 and if the preferred first-line biologic changed after the introduction of biosimilar infliximab.

Methods

Data were collected from the Norwegian Patient Registry (NPR) and the Norwegian Prescription Database (NorPD). The study cohort was defined as all patients with at least two registered K50 (CD) within 1 year between 2011 and 2016. Patients were followed for 1 year after identification of first diagnosis code. The use of biologics is recorded with ATC codes for each patient in NPR and NorPD. The ATC codes do not distinguish between biosimilars and originators. Patients were stratified by the year of first diagnosis in order to examine change over time.

Results

A total of 4972 patients were included in the study. The total use of biologics stratified by year is shown in Figure 1. The proportion of patients receiving biologics within 1 year of diagnosis increased significantly from 21% in 2011 to 33% in 2016 (p < 0.0001). The proportion of patients receiving adalimumab as their first biologic after 1 year of diagnosis was 11% in 2011 compared with 4% in 2016. Opposed to this, the use of infliximab increased from 10% in 2011 to 28% in 2016. From 2011 to 2013, adalimumab was the preferred first-line biologic and this changed to infliximab after 2014.

Figure 1. Cumulative probability of receiving a biologic within 1 year of diagnosis.

Conclusion

There was a significant increase in the proportion of patients who received biologics within the first year of diagnosis between 2011 and 2016. After the introduction of biosimilars in 2014, infliximab became the preferred first-line biologic.