Biological and Immunomodulator Use in Crohn's Disease in a Medicaid Population
Mark H Flasar1, Jingdong Chao, A Burak Ozbay
1*Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland; †AbbVie Inc., North Chicago, Illinois; and ‡Analysis Group Inc., Boston, Massachusetts.
Insights
Treatment disparities in Crohn's disease (CD) may affect Hispanic (H) patients with severe disease. African Americans (AA) and Whites (W) showed similar use of immunomodulators and biologics for CD. Further research is needed for H patients.
Area of Science:
- Gastroenterology and Hepatology
- Health Services Research
- Pharmacoeconomics
Background:
- Previous reports suggest lower use of immunomodulators and biologics in African Americans (AA) with Crohn's disease (CD) compared to Whites (W).
- Limited data exist regarding treatment disparities for Hispanic (H) populations with CD.
- Understanding racial and ethnic differences in biologic and immunomodulator use is crucial for equitable CD management.
Purpose of the Study:
- To investigate potential racial and ethnic disparities in the initiation of immunomodulators and biologics among patients with Crohn's disease (CD).
- To compare the utilization of biologic therapies for CD across White (W), African American (AA), and Hispanic (H) patient groups.
- To assess the impact of disease severity on treatment access for different racial and ethnic groups with CD.
Main Methods:
- Analysis of Medicaid databases from three states (August 1998-July 2009) for patients diagnosed with Crohn's disease (CD).
- Assessment of CD-related treatments, comorbidities, healthcare utilization, and time to first biologic claim.
- Application of Cox proportional hazard regression models to evaluate the effect of race and ethnicity on biologic initiation, adjusting for covariates and disease severity.
Main Results:
- No significant differences in immunomodulator initiation were observed between White (W), African American (AA), and Hispanic (H) patients (18%, 17%, 17% respectively).
- Overall biologic initiation rates were similar across W, AA, and H patients (7%, 9%, 5% respectively); adjusted models showed no significant disparities between AA and W, or H and W.
- However, after adjusting for disease severity (hospitalization post-diagnosis), Hispanic (H) patients were significantly less likely to initiate biologics compared to White (W) patients (hazard ratio 0.40).
Conclusions:
- Disparities in immunomodulator or biologic use between African Americans (AA) and Whites (W) with Crohn's disease (CD) may not be significant.
- Hispanic (H) patients with more severe CD may face significant barriers to accessing biologic therapies compared to White (W) patients.
- Further research is warranted to confirm these findings and explore the underlying reasons for treatment disparities in specific populations with severe CD.
Background:
Immunomodulator and biological use in African Americans (AA) with Crohn's disease (CD) has been reported to be lower than in whites (W); less data exist for Hispanics (H).
Methods:
Medicaid databases from 3 states were examined for patients with CD from August 1998 to July 2009. CD-related treatments, comorbidities, location, surgery, and health care utilization were assessed from diagnosis until the first biological claim or end of claims. A Cox proportional hazard regression model was used to assess the effect of race on biological initiation.
Results:
A total of 5575 patients with CD (3590 W; 924 AA; 494 H; and 567 "other") were analyzed; 18%, 17%, and 17% of W, AA, and H patients, respectively, started immunomodulators (P = not significant); and 7%, 9%, and 5% of W, AA, and H, respectively, initiated biologics after CD diagnosis (P = not significant). After adjusting for demographics and CD-related medications and comorbidities in Cox models, no association was found between AA and W for biological use (hazard ratio 1.19; 95% confidence interval [CI], 0.91-1.54) or H and W (hazard ratio 0.68, 95% CI, 0.45-1.02). Analyzing patients hospitalized after CD diagnosis (n = 3428) to adjust for disease severity demonstrated that H were significantly less likely to use biologics than W (hazard ratio 0.40, 95% CI, 0.22-0.74). No differences between W and AA were found.
Conclusions:
Our findings suggest that differences between AA and W in exposure to immunomodulators or biologics may not exist, although they may be present in H with more severe disease. Further research is needed to confirm these findings.
Related Concept Videos
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...