This study was funded by UCB.
Response to biologic therapy in Crohn's disease is improved with early treatment: An analysis of health claims data†
Article first published online: 22 FEB 2012
Copyright © 2012 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 12, pages 2225–2231, December 2012
How to Cite
Rubin, D. T., Uluscu, O. and Sederman, R. (2012), Response to biologic therapy in Crohn's disease is improved with early treatment: An analysis of health claims data. Inflamm Bowel Dis, 18: 2225–2231. doi: 10.1002/ibd.22925
- Issue published online: 15 NOV 2012
- Article first published online: 22 FEB 2012
- Manuscript Accepted: 31 JAN 2012
- Manuscript Received: 18 DEC 2011
- PAREXEL company, US
- inflammatory bowel disease;
- tumor necrosis factor
Anti-tumor necrosis factor (TNF) therapy is an important treatment option for management of active Crohn's disease (CD) and is labeled for use after failure of conventional therapy (step-up). However, there is debate on the introduction of anti-TNF agents earlier in the treatment strategy (top-down) to potentially improve clinical outcomes. The aim of this study was to determine if a top-down approach with anti-TNF therapy is associated with improved outcomes for patients with active CD.
Claims data were from adult patients with CD with continuous enrollment in the same health plan for ≥6 months prior to the initial diagnostic claim for CD, ≥12 months after their initial anti-TNF claim, and with ≥1 anti-TNF claims after their initial diagnosis for CD.
Three patient groups were identified: The Step-Up group used 5-aminosalicylates and/or corticosteroids prior to anti-TNF; the immunosuppression (IS)-to-TNF inhibitor group used IS prior to anti-TNF therapy; the Early-TNF group initiated anti-TNF therapy within 30 days of the first prescription for CD. Response to anti-TNF therapy was determined up to 24 months following anti-TNF initiation by concomitant corticosteroid use, CD surgery, anti-TNF dose escalation, and anti-TNF discontinuation/switch. A top-down approach to anti-TNF therapy was associated with a lower risk of concomitant corticosteroid use, anti-TNF dose escalation, discontinuation/switch of anti-TNF, and CD-related surgery compared with the step-up and IS-to-TNF therapy approaches.
These “real-world” data show that a top-down approach to anti-TNF therapy in CD is associated with reductions in loss of response and fewer surgeries than conventional step-wise management. (Inflamm Bowel Dis 2012;)