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News

Suboptimal therapy among ulcerative colitis and Crohn's disease patients

The latest issue of the Alimentary Pharmacology & Therapeutics performs a real-world assessment of therapy changes, suboptimal treatment and associated costs in patients with ulcerative colitis or Crohn's disease.

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Treatments for Crohn's disease and ulcerative colitis are not uniformly effective, thus necessitating dose changes, switching, and augmentation and carry adverse event risk, often requiring discontinuation, which reduces treatment benefits.

Dr Rubin and colleagues from Illinois, USA assessed continuity of and changes to initial Crohn's disease and ulcerative colitis treatments, as well as costs associated with specific parameters defining suboptimal therapy.

Commercial US insurance claims were retrospectively analyzed.

Crohn's disease and ulcerative colitis patients receiving monotherapy with 5-aminosalicylates (5-ASAs), corticosteroids, immunomodulators (IM) or biologics were included.

Continuity of and changes to initial therapy and associated costs were assessed over 12 months following therapy initiation.

80% of patients had 1 or more suboptimal therapy markers
Alimentary Pharmacology & Therapeutics

Suboptimal therapy included discontinuation or switch, dose escalation, augmentation, inadequate loading, prolonged corticosteroids use, surgery or hospitalization.

The researchers included 13,005 Crohn's disease, and 19,878 ulcerative colitis patients.

Augmentation was a common index therapy change in both Crohn's disease and ulcerative colitis patients.

The research team found that approximately 50% of Crohn's disease, and ulcerative colitis 5-ASA initiators discontinued/interrupted treatment.

The team noted that approximately 80% of Crohn's disease, and ulcerative colitis patients had 1 or more suboptimal therapy markers.

The research team observed that mean all-cause total costs per Crohn's disease patient were significantly higher in those with vs without suboptimal therapy.

The team noted that in ulcerative colitis, the disparity was smaller.

Dr Rubin's team concludes, "Frequent dose and treatment changes were observed in all classes of initial ulcerative colitis and Crohn's disease treatments."

"The economic impact of suboptimal therapy among ulcerative colitis and Crohn's disease patients is substantial."

Aliment Pharmacol Ther 2014: 39(10): 1143–1155
07 May 2014

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