Treatment sequences, outcomes, healthcare utilization, and costs in patients with inflammatory bowel diseases requiring advanced treatment-real world comparative effectiveness from German claims data.

BACKGROUND: There is limited data on inflammatory bowel disease advanced therapy sequences. Therefore, we examined real-world advanced therapy sequences to compare persistence, healthcare use and costs in first-line advanced therapy.

METHODS: Evaluable patient characteristics, treatments, sequences, and outcomes were extracted from the WIG2 claims benchmark database and observed from 2014 to 2021. Therapeutic effectiveness (persistence without discontinuation or inadequate response), healthcare resource utilization, and associated costs were analyzed. Advanced treatment group differences were adjusted by inverse probability weighting.

RESULTS: Two thousand nine hundred forty-eight patients with Crohn's disease or ulcerative colitis initiated at least one of the following advanced therapies during the study period: adalimumab (1,260), golimumab (111), infliximab (1,035), tofacitinib (17), ustekinumab (138) or vedolizumab (387). In patients with ulcerative colitis, vedolizumab as first-line advanced therapy demonstrated superior effectiveness in persistence without inadequate response over three years compared to infliximab (p < 0.05). Patients taking infliximab or ustekinumab had higher disease-related costs than those taking adalimumab, golimumab, tofacitinib or vedolizumab. In Crohn's disease patients, first-line treatment with adalimumab (p < 0.001), ustekinumab (p < 0.001) and vedolizumab (p < 0.017), showed superior persistence over 3 years compared to infliximab, and time to inadequate response was longer in patients taking adalimumab and vedolizumab (p < 0.001). Disease-specific treatment costs were lower in patients receiving adalimumab or vedolizumab as first-line advanced therapy. Compared to infliximab, patients treated with ustekinumab had significantly higher costs.

CONCLUSIONS: Anti-TNF agents were most frequently used in first-line advanced therapy; however, vedolizumab appeared to be a preferred choice in terms of persistence and cost measures over three years from the start of treatment.