Effectiveness of early treatment with biologics and immunomodulator therapy on healthcare utilization remains poorly defined.
Dr Neena Abraham and colleagues from Arizona, USA assessed rates of hospitalization and surgery within 1 year after initiation of infliximab and/or immunomodulator therapy in a United States cohort of patients with inflammatory bowel disease.
The researchers conducted a retrospective, observational cohort study of veterans with Crohn’s disease or ulcerative colitis by using administrative data from 176 Department of Veteran Affairs facilities.
Inpatient, outpatient, and death records were linked longitudinally with prescription fill data.
|A 50% relative reduction in surgery occurred after 5 months of dual therapy|
|Clinical Gastroenterology & Hepatology|
Each person-day of follow-up was assessed for treatment with infliximab, immunomodulators, both (dual therapy), or neither.
The researchers calculated drug exposure time and used Poisson and logistic regression analyses to assess outcomes.
The team reported that the cohort of 20,474 patients included 8042 patients with Crohn’s disease, and 12,432 with ulcerative colitis prescribed infliximab, immunomodulator, or dual therapy.
Adjusted models revealed 50% relative reductions in hospitalization among patients who received 9 months of immunomodulator monotherapy, 8 months of infliximab, or 7.7 months of dual therapy.
The research team found that a 50% relative reduction in surgery was observed among patients receiving 7 months of infliximab or 5 months of dual therapy.
Analysis of dose-response data revealed 73% and 92% reductions in risk of hospitalization and surgery, respectively, after 9 months of dual therapy.
Dr Abraham's team commented, "On the basis of a retrospective cohort study, dual therapy with infliximab and an immunomodulator for less than 8 months is associated with significant reductions in hospitalization, and surgery within 1 year of the start of therapy."
"These findings indicate that patients with IBD are more likely to benefit if dual therapy is initiated earlier in their first year of therapy."