Trends in the use of biologicals and their treatment outcomes among patients with inflammatory bowel diseases – a Danish nationwide cohort study
Summary Background Therapeutic management of inflammatory bowel diseases (IBD) is rapidly evolving, with an expanding armoury of biological drugs at our disposal. However, real‐world findings about treatment persistence and the impact of biologicals on surgery remain inconsistent. Aims This study ai...
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| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2022-03, Vol.55 (5), p.541-557 |
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| creator | Zhao, Mirabella Sall Jensen, Morten Knudsen, Torben Kelsen, Jens Coskun, Mehmet Kjellberg, Jakob Burisch, Johan |
| description | Summary
Background
Therapeutic management of inflammatory bowel diseases (IBD) is rapidly evolving, with an expanding armoury of biological drugs at our disposal. However, real‐world findings about treatment persistence and the impact of biologicals on surgery remain inconsistent.
Aims
This study aimed to investigate trends in biological use and surgery rates in a nationwide cohort of biological‐naïve IBD patients.
Methods
Patients with IBD who initiated biological treatment between 2011 and 2018 were identified in the Danish National Patient Registry. Data on use of biologicals, surgeries and healthcare costs were retrieved and analysed for time trends.
Results
Between 2011 and 2018, a total of 6,036 IBD (51% ulcerative colitis (UC), 49% Crohn's disease (CD)) patients received biological treatment for the first time. Cumulative use of biologicals increased from 5.0% to 10.8% among UC and 8.9%‐14.5% among CD patients. Infliximab remained the most‐prescribed first‐line biological for UC and CD. Treatment persistence was 44.3% and 16.9% after 1 and 3 years in UC, compared to 59.9% and 33.6% in CD patients. Overall, 32.8% of patients switched to a second biological. Surgery rates decreased in both UC (P = 0.015) and CD (P = 0.008) patients and remained significant for UC in the Cox regression model (P = 0.002). Outpatient and surgical costs also fell among both UC and CD patients.
Conclusions
Persistence rates for first‐line biologicals among IBD patients were low and one‐third switched treatment. Surgery rates and direct costs decreased over time, but whether this is related to the use of biologicals has yet to be determined.
Trends in the use of biologics for patients with inflammatory bowel disease and their outcomes in Denmark 2011–2018. |
| doi_str_mv | 10.1111/apt.16723 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2623075241</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2623075241</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3883-aa454876bdc8f8c95603f6e00901662bc88cd405dbd03012a03cba66ff1dad1a3</originalsourceid><addsrcrecordid>eNp10cFuFCEYB3BibOxaPfgChsSLHqb9gBmGOTZVq0kTPaznyTfAdGlmYAUmm735DPqGPolst3poIhcSvh9_SP6EvGJwzsq6wG0-Z7Ll4glZMSGbioOQT8kKuOwqrpg4Jc9TugMA2QJ_Rk5FrRSrRbciP9fRepOo8zRvLF2SpWGkgwtTuHUap0TRm8PIRZqjxTxbn2lYsg6zLcM5-Fu6xezKcaI7lzclapxwnjGHuKdD2NmJGpcspuJ___hFkb5H79KG-nIt-J0zluqwCTHTlBezf0FOxvKwffmwn5FvHz-srz5VN1-uP19d3lRaKCUqxLqpVSsHo9WodNdIEKO0AB0wKfmgldKmhsYMBgQwjiD0gFKOIzNoGIoz8vaYu43h-2JT7meXtJ0m9DYsqeeSC2gbXrNC3zyid2GJvvzuoGTXQctlUe-OSseQUrRjv41uxrjvGfSHovpSVH9fVLGvHxKXYbbmn_zbTAEXR7Bzk93_P6m__Lo-Rv4B2mef9g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2626990726</pqid></control><display><type>article</type><title>Trends in the use of biologicals and their treatment outcomes among patients with inflammatory bowel diseases – a Danish nationwide cohort study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Online Library Free Content</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Zhao, Mirabella ; Sall Jensen, Morten ; Knudsen, Torben ; Kelsen, Jens ; Coskun, Mehmet ; Kjellberg, Jakob ; Burisch, Johan</creator><creatorcontrib>Zhao, Mirabella ; Sall Jensen, Morten ; Knudsen, Torben ; Kelsen, Jens ; Coskun, Mehmet ; Kjellberg, Jakob ; Burisch, Johan</creatorcontrib><description>Summary
Background
Therapeutic management of inflammatory bowel diseases (IBD) is rapidly evolving, with an expanding armoury of biological drugs at our disposal. However, real‐world findings about treatment persistence and the impact of biologicals on surgery remain inconsistent.
Aims
This study aimed to investigate trends in biological use and surgery rates in a nationwide cohort of biological‐naïve IBD patients.
Methods
Patients with IBD who initiated biological treatment between 2011 and 2018 were identified in the Danish National Patient Registry. Data on use of biologicals, surgeries and healthcare costs were retrieved and analysed for time trends.
Results
Between 2011 and 2018, a total of 6,036 IBD (51% ulcerative colitis (UC), 49% Crohn's disease (CD)) patients received biological treatment for the first time. Cumulative use of biologicals increased from 5.0% to 10.8% among UC and 8.9%‐14.5% among CD patients. Infliximab remained the most‐prescribed first‐line biological for UC and CD. Treatment persistence was 44.3% and 16.9% after 1 and 3 years in UC, compared to 59.9% and 33.6% in CD patients. Overall, 32.8% of patients switched to a second biological. Surgery rates decreased in both UC (P = 0.015) and CD (P = 0.008) patients and remained significant for UC in the Cox regression model (P = 0.002). Outpatient and surgical costs also fell among both UC and CD patients.
Conclusions
Persistence rates for first‐line biologicals among IBD patients were low and one‐third switched treatment. Surgery rates and direct costs decreased over time, but whether this is related to the use of biologicals has yet to be determined.
Trends in the use of biologics for patients with inflammatory bowel disease and their outcomes in Denmark 2011–2018.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.16723</identifier><identifier>PMID: 34881439</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Biological products ; biological treatment ; Bowel disease ; Cohort analysis ; Cohort Studies ; Colitis, Ulcerative - surgery ; Crohn's disease ; Denmark - epidemiology ; direct cost ; Disease management ; epidemiology ; Humans ; Inflammatory bowel diseases ; Inflammatory Bowel Diseases - drug therapy ; Inflammatory Bowel Diseases - surgery ; Infliximab ; Intestine ; Monoclonal antibodies ; Patients ; Surgery ; Treatment Outcome ; Trends ; Tumor necrosis factor-α ; Ulcerative colitis</subject><ispartof>Alimentary pharmacology & therapeutics, 2022-03, Vol.55 (5), p.541-557</ispartof><rights>2021 John Wiley & Sons Ltd</rights><rights>2021 John Wiley & Sons Ltd.</rights><rights>Copyright © 2022 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3883-aa454876bdc8f8c95603f6e00901662bc88cd405dbd03012a03cba66ff1dad1a3</citedby><cites>FETCH-LOGICAL-c3883-aa454876bdc8f8c95603f6e00901662bc88cd405dbd03012a03cba66ff1dad1a3</cites><orcidid>0000-0002-3312-5139 ; 0000-0002-8392-4860</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.16723$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.16723$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34881439$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhao, Mirabella</creatorcontrib><creatorcontrib>Sall Jensen, Morten</creatorcontrib><creatorcontrib>Knudsen, Torben</creatorcontrib><creatorcontrib>Kelsen, Jens</creatorcontrib><creatorcontrib>Coskun, Mehmet</creatorcontrib><creatorcontrib>Kjellberg, Jakob</creatorcontrib><creatorcontrib>Burisch, Johan</creatorcontrib><title>Trends in the use of biologicals and their treatment outcomes among patients with inflammatory bowel diseases – a Danish nationwide cohort study</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Therapeutic management of inflammatory bowel diseases (IBD) is rapidly evolving, with an expanding armoury of biological drugs at our disposal. However, real‐world findings about treatment persistence and the impact of biologicals on surgery remain inconsistent.
Aims
This study aimed to investigate trends in biological use and surgery rates in a nationwide cohort of biological‐naïve IBD patients.
Methods
Patients with IBD who initiated biological treatment between 2011 and 2018 were identified in the Danish National Patient Registry. Data on use of biologicals, surgeries and healthcare costs were retrieved and analysed for time trends.
Results
Between 2011 and 2018, a total of 6,036 IBD (51% ulcerative colitis (UC), 49% Crohn's disease (CD)) patients received biological treatment for the first time. Cumulative use of biologicals increased from 5.0% to 10.8% among UC and 8.9%‐14.5% among CD patients. Infliximab remained the most‐prescribed first‐line biological for UC and CD. Treatment persistence was 44.3% and 16.9% after 1 and 3 years in UC, compared to 59.9% and 33.6% in CD patients. Overall, 32.8% of patients switched to a second biological. Surgery rates decreased in both UC (P = 0.015) and CD (P = 0.008) patients and remained significant for UC in the Cox regression model (P = 0.002). Outpatient and surgical costs also fell among both UC and CD patients.
Conclusions
Persistence rates for first‐line biologicals among IBD patients were low and one‐third switched treatment. Surgery rates and direct costs decreased over time, but whether this is related to the use of biologicals has yet to be determined.
Trends in the use of biologics for patients with inflammatory bowel disease and their outcomes in Denmark 2011–2018.</description><subject>Biological products</subject><subject>biological treatment</subject><subject>Bowel disease</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Colitis, Ulcerative - surgery</subject><subject>Crohn's disease</subject><subject>Denmark - epidemiology</subject><subject>direct cost</subject><subject>Disease management</subject><subject>epidemiology</subject><subject>Humans</subject><subject>Inflammatory bowel diseases</subject><subject>Inflammatory Bowel Diseases - drug therapy</subject><subject>Inflammatory Bowel Diseases - surgery</subject><subject>Infliximab</subject><subject>Intestine</subject><subject>Monoclonal antibodies</subject><subject>Patients</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Trends</subject><subject>Tumor necrosis factor-α</subject><subject>Ulcerative colitis</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10cFuFCEYB3BibOxaPfgChsSLHqb9gBmGOTZVq0kTPaznyTfAdGlmYAUmm735DPqGPolst3poIhcSvh9_SP6EvGJwzsq6wG0-Z7Ll4glZMSGbioOQT8kKuOwqrpg4Jc9TugMA2QJ_Rk5FrRSrRbciP9fRepOo8zRvLF2SpWGkgwtTuHUap0TRm8PIRZqjxTxbn2lYsg6zLcM5-Fu6xezKcaI7lzclapxwnjGHuKdD2NmJGpcspuJ___hFkb5H79KG-nIt-J0zluqwCTHTlBezf0FOxvKwffmwn5FvHz-srz5VN1-uP19d3lRaKCUqxLqpVSsHo9WodNdIEKO0AB0wKfmgldKmhsYMBgQwjiD0gFKOIzNoGIoz8vaYu43h-2JT7meXtJ0m9DYsqeeSC2gbXrNC3zyid2GJvvzuoGTXQctlUe-OSseQUrRjv41uxrjvGfSHovpSVH9fVLGvHxKXYbbmn_zbTAEXR7Bzk93_P6m__Lo-Rv4B2mef9g</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Zhao, Mirabella</creator><creator>Sall Jensen, Morten</creator><creator>Knudsen, Torben</creator><creator>Kelsen, Jens</creator><creator>Coskun, Mehmet</creator><creator>Kjellberg, Jakob</creator><creator>Burisch, Johan</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3312-5139</orcidid><orcidid>https://orcid.org/0000-0002-8392-4860</orcidid></search><sort><creationdate>202203</creationdate><title>Trends in the use of biologicals and their treatment outcomes among patients with inflammatory bowel diseases – a Danish nationwide cohort study</title><author>Zhao, Mirabella ; Sall Jensen, Morten ; Knudsen, Torben ; Kelsen, Jens ; Coskun, Mehmet ; Kjellberg, Jakob ; Burisch, Johan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3883-aa454876bdc8f8c95603f6e00901662bc88cd405dbd03012a03cba66ff1dad1a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Biological products</topic><topic>biological treatment</topic><topic>Bowel disease</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Colitis, Ulcerative - surgery</topic><topic>Crohn's disease</topic><topic>Denmark - epidemiology</topic><topic>direct cost</topic><topic>Disease management</topic><topic>epidemiology</topic><topic>Humans</topic><topic>Inflammatory bowel diseases</topic><topic>Inflammatory Bowel Diseases - drug therapy</topic><topic>Inflammatory Bowel Diseases - surgery</topic><topic>Infliximab</topic><topic>Intestine</topic><topic>Monoclonal antibodies</topic><topic>Patients</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Trends</topic><topic>Tumor necrosis factor-α</topic><topic>Ulcerative colitis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhao, Mirabella</creatorcontrib><creatorcontrib>Sall Jensen, Morten</creatorcontrib><creatorcontrib>Knudsen, Torben</creatorcontrib><creatorcontrib>Kelsen, Jens</creatorcontrib><creatorcontrib>Coskun, Mehmet</creatorcontrib><creatorcontrib>Kjellberg, Jakob</creatorcontrib><creatorcontrib>Burisch, Johan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhao, Mirabella</au><au>Sall Jensen, Morten</au><au>Knudsen, Torben</au><au>Kelsen, Jens</au><au>Coskun, Mehmet</au><au>Kjellberg, Jakob</au><au>Burisch, Johan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trends in the use of biologicals and their treatment outcomes among patients with inflammatory bowel diseases – a Danish nationwide cohort study</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2022-03</date><risdate>2022</risdate><volume>55</volume><issue>5</issue><spage>541</spage><epage>557</epage><pages>541-557</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Therapeutic management of inflammatory bowel diseases (IBD) is rapidly evolving, with an expanding armoury of biological drugs at our disposal. However, real‐world findings about treatment persistence and the impact of biologicals on surgery remain inconsistent.
Aims
This study aimed to investigate trends in biological use and surgery rates in a nationwide cohort of biological‐naïve IBD patients.
Methods
Patients with IBD who initiated biological treatment between 2011 and 2018 were identified in the Danish National Patient Registry. Data on use of biologicals, surgeries and healthcare costs were retrieved and analysed for time trends.
Results
Between 2011 and 2018, a total of 6,036 IBD (51% ulcerative colitis (UC), 49% Crohn's disease (CD)) patients received biological treatment for the first time. Cumulative use of biologicals increased from 5.0% to 10.8% among UC and 8.9%‐14.5% among CD patients. Infliximab remained the most‐prescribed first‐line biological for UC and CD. Treatment persistence was 44.3% and 16.9% after 1 and 3 years in UC, compared to 59.9% and 33.6% in CD patients. Overall, 32.8% of patients switched to a second biological. Surgery rates decreased in both UC (P = 0.015) and CD (P = 0.008) patients and remained significant for UC in the Cox regression model (P = 0.002). Outpatient and surgical costs also fell among both UC and CD patients.
Conclusions
Persistence rates for first‐line biologicals among IBD patients were low and one‐third switched treatment. Surgery rates and direct costs decreased over time, but whether this is related to the use of biologicals has yet to be determined.
Trends in the use of biologics for patients with inflammatory bowel disease and their outcomes in Denmark 2011–2018.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34881439</pmid><doi>10.1111/apt.16723</doi><tpages>17</tpages><orcidid>https://orcid.org/0000-0002-3312-5139</orcidid><orcidid>https://orcid.org/0000-0002-8392-4860</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Biological products biological treatment Bowel disease Cohort analysis Cohort Studies Colitis, Ulcerative - surgery Crohn's disease Denmark - epidemiology direct cost Disease management epidemiology Humans Inflammatory bowel diseases Inflammatory Bowel Diseases - drug therapy Inflammatory Bowel Diseases - surgery Infliximab Intestine Monoclonal antibodies Patients Surgery Treatment Outcome Trends Tumor necrosis factor-α Ulcerative colitis |
| title | Trends in the use of biologicals and their treatment outcomes among patients with inflammatory bowel diseases – a Danish nationwide cohort study |
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