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).
Conclusions: 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.