Earlier anti-TNF reduces healthcare utilization in CD

March 17, 2022

2 minute read

Source/Disclosures

Disclosures:
Targownik reports receiving research-initiated funding from Janssen Canada and serving on advisory boards in Canada for AbbVie, Janssen, Merck, Pfizer, Roche, Sandoz and Takeda. Please see the study for relevant financial information from all other authors.


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According to research, early administration of anti-tumor necrosis factor therapy reduced the use of healthcare resources in patients with Crohn’s disease, but not in patients with ulcerative colitis.

“The direct costs related to the availability of these agents continue to rise and now represent the largest portion of healthcare expenditures for patients with IBD,” Laura E. TargonikMD, MSHS, associate professor of gastroenterology and hepatology at the University of Toronto, and his colleagues wrote. “Furthermore, there is equivocal evidence as to whether the introduction of anti-TNFs as a treatment option had a significant impact on rates of hospitalization or surgery in the population, suggesting that these agents may not be used optimally in clinical practice.”

In a later interview, Targownik told Healio, “We wanted to understand the long-term impact of initiating biologic treatment early in people with IBD.”

Targownik and colleagues sought to study and compare overall healthcare utilization rates after initiation of anti-TNFs by evaluating 1,060 patients newly diagnosed with IBD (742 CD, 318 UC) using health administrative data from Manitoba, Canada. Data collected included rates of hospitalization, surgery, and outpatient visits before and up to 5 years after initiation of anti-TNF therapy.

The researchers further compared healthcare utilization rates between patients who received anti-TNFs within 2 years of their diagnosis (early initiators) and patients who received anti-TNFs more than 2 years after their diagnosis. diagnosis (late initiators). The median time between diagnosis and initiation of anti-TNF was 4.43 years (IQR 1.31-12.16).

Among CD patients, early initiators had a lower rate of IBD-specific hospitalizations in the third to fifth year following initiation of anti-TNFs as well as a lower overall hospitalization rate during the fourth and fifth years after initiation.

Over the 5 years of follow-up, researchers noted that early initiators had a lower cumulative rate of IBD-specific hospitalizations (4 per 100 person-years versus 8.6 per 100 person-years; difference in rate of ‘impact [IRD]: –4.5 per 100 person-years; 95% CI, -7 to -2.1) and all-cause hospitalizations (23.1 versus 33.5; TDI: -10.4; 95% CI, -17 to -3.7). This group also had lower rates of IBD-specific surgical resection (IRD: -3.6; 95% CI -5.3 to -1.9), overall outpatient visits (14.8 per year versus 19.1 per year; IRD: -4.3; 95% CI, –5.4 to –3.2) and the cumulative cost of care.

Among patients with UC, Targownik and colleagues found no significant difference between early and late initiators for hospitalization rates (IBD-specific: 3.8 versus 5.9; all-cause: 26.5 versus 24.1), cumulative surgery rates (7.7 versus 6; IRD: 1.7; 95% CI, -2.5 to 5.9), outpatient visits or cost of using health care health.

“For patients with Crohn’s disease, there is a significant reduction in IBD-related hospitalizations, surgeries and non-drug costs in people who receive anti-TNFs within 2 years of diagnosis and these savings are continue for at least 5 years after the start of biological treatment. Targonik said. “We hope this will provide more support for better coverage of payers for earlier access to these potentially disease-modifying therapies.”

Targownik suggested further research to determine why the same effect was not seen in patients with UC.

Jack L. Goldstein