There are few published studies that evaluate the adherence of Crohn's disease (CD) patients with tumor necrosis factor alpha (TNFα) antagonist therapy.1 A home health program sponsored by UCB Pharma provides skilled nurses that assist CD patients at home with the administration of their prescribed certolizumab pegol (CZP) treatment. The aim of this analysis was to determine if assistance by a home health nurse had an impact on patients' adherence with CZP therapy.Methods:
A retrospective analysis of US patient claims data from PharMetrics Plus from January 1, 2008 to September 30, 2014 was conducted. Eligible patients starting the nurse assistance program had to have a CD diagnosis on index date (start of CZP) or in the pre-index period; had to be continually enrolled in the 12 months prior to the index date and for ≥60 days after the index date; and had to have evidence of a first CZP prescription fill within 60 days before or 60 days after program initiation. Patients were excluded if they had a diagnosis of rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. Patients could receive nurse-administered CZP injections or receive instructions by a nurse on self-administration (or both). Exact matching of baseline characteristics was performed on gender and categorical age, with a 1:1 ratio of patients with/without assistance; all other baseline characteristics were well balanced. Adherence to CZP treatment was determined using the medication possession ratio (MPR) and the proportion of days covered (PDC) measures. For this analysis, adherence was defined as either an MPR or a PDC value of ≥80%. Discontinuation was defined as a gap of ≥45 days between end of day's supply and the next fill. A Kaplan-Meier survival analysis was performed to compare time to discontinuation of CZP treatment between patients who received nurse assistance versus those that did not.Results:
A total of 548 patients were evaluated for adherence for this analysis (n = 274 in each cohort). In the nurse assistance cohort, the mean MPR values were higher than in the cohort without nurse assistance (mean [range], 0.65 [0.04–1.0] versus 0.57 [0.04–1.0]; P = 0.0029). Similarly, the mean PDC values were higher with nurse assistance than without (mean [range], 0.62 [0.04–1.0] versus 0.54 [0.04–1.0]; P = 0.0029). A higher percentage of patients had an MPR ≥80% than in the cohort without nurse assistance (45.3% versus 37.3%; P = 0.0572). Furthermore, a higher percentage of patients with nurse assistance had a PDC value ≥80% than patients without nurse assistance (40.2% versus 33.7%; P = 0.1125). Time to discontinuation of treatment was significantly longer in patients who received CZP with nurse assistance than those without (P = 0.0008).Conclusions:
Patients who received CZP with the assistance of a home health nurse had better adherence with CZP and remained on treatment significantly longer than patients without nurse assistance.Conclusions:
This study was sponsored by UCB Pharma.