Therapy Persistence and Dose Escalation of Advanced Treatments in First and Second Line of Ulcerative Colitis and Crohn's Disease - A Retrospective Cohort Analysis of Healthcare Claims Data.

BACKGROUND

There is limited data on advanced therapy outcomes in second-line vs. first-line advanced treatment of patients with ulcerative colitis (UC) and Crohn's disease (CD).

METHODS

We conducted a retrospective health claims study of patients with UC and CD in Germany. We analyzed claims data from 2014 to 2021, and compared therapy persistence and dose escalation in first- (1L) and second-line (2L) advanced therapy. Our analysis included the approved therapies adalimumab (ADA), infliximab (IFX), ustekinumab (UST) and vedolizumab (VDZ) for both UC and CD patients and golimumab (GOL) and tofacitinib (TOF) for UC patients.

RESULTS

2,948 patients were included in the study and initiated 1L advanced therapy. Of these, 823 patients started a 2L advanced therapy. Time on treatment was generally shorter in 2L compared to 1L: In UC patients, persistence rates at 2 years ranged from 52.5% to 71.9% for 1L, and from 40.1% to 69.1% for 2L. In CD patients, persistence rates ranged from 66.6% to 86.6% for 1L, and from 59.9% to 74.3% for 2L. We observed more frequent dose escalations in 2L than in 1L for all advanced therapies except GOL in UC patients.

CONCLUSIONS

Our study indicates that advanced therapies have shorter persistence and require higher doses when used as 2L treatment compared to 1L treatment. Future studies on reliable response predictors in patients with UC or CD receiving advanced treatments are likely to improve the selection of more efficacious 1L therapy.