Epidemiology and Steroid Dependency Reduction in Crohn's Disease During the Biologics Era: A Nationwide
Nai-Yu Chen1,2, Chiao-Hsiung Chuang3, Yu-Ching Chang4
1School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1, University Road, 70101, Tainan, Taiwan.
Insights
Biologics in Crohn's disease (CD) management increased immunomodulator use and decreased steroid dependency. This study analyzed prescription trends and steroid dependence in CD patients before and after biologic introduction.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Crohn's disease (CD) is a significant inflammatory bowel disease (IBD) with increasing prevalence.
- Understanding treatment evolution, particularly the impact of biologics, is crucial for managing CD.
Purpose of the Study:
- To evaluate the influence of biologic therapies on prescription patterns in Crohn's disease.
- To assess changes in steroid dependency rates following the introduction of biologics.
Main Methods:
- Retrospective longitudinal analysis of insurance claims data from 4476 CD patients.
- Study divided into pre-biologics and post-biologics eras based on initial CD-related prescription.
- Examined prescription trends, steroid dependency, and concurrent use of immunomodulators or biologics.
Main Results:
- CD incidence remained stable in Taiwan (1.6-1.3/100,000) from 2006-2018.
- Post-biologics era saw increased initial immunomodulator prescription (5.8% to 14.7%) and decreased steroid dependency (25.5 to 22.1 per 1000 person-years).
- Concurrent immunomodulator use in steroid-dependent patients rose significantly in the post-biologics era (6.1% to 24.2%).
Conclusions:
- Biologics approval and policy changes in Taiwan led to increased immunomodulator utilization.
- The introduction of biologics correlated with a reduction in steroid dependency among Crohn's disease patients.
Introduction:
Crohn's disease (CD), a subtype of inflammatory bowel disease, is a growing health concern. In this study, we examined the influence of biologics on prescription trends and steroid dependency.
Methods:
This retrospective longitudinal analysis of insurance coverage spanned at least 1 year before and 1 year after the inflammatory bowel disease diagnosis and enrolled 4476 patients with CD. The study period was divided into the pre-biologics and post-biologics eras according to the date when the first CD-related prescription was issued. We examined prescription patterns, steroid dependency rates, and concurrent use of immunomodulators or biologics.
Results:
The CD incidence ranged from 1.6 to 1.3 cases per 100,000 patients between 2006 and 2018. During the pre-biologics era, the initial medications primarily comprised steroids (76.2%), followed by 5-aminosalicylic acid (44%) and immunomodulators (5.8%). During the post-biologics era, the initial prescription rates of steroids (69.8%) and 5-aminosalicylic acid (60.5%) remained high, and the Immunomodulators prescription rate increased to 14.7%. Steroid dependency was observed in 25.5 of 1000 and 22.1 of 1000 person-years during the pre-biologics and post-biologics eras, respectively. In the pre-biologics era, 6.1% of patients with steroid dependence received concurrent treatment with immunomodulators within the first 6 months. In the post-biologics era, this percentage increased to 24.2%, with some patients receiving immunomodulators or biologics.
Conclusions:
The incidence rate in Taiwan showed a stable trend annually. Biologics approval and policy implementation resulted in increased immunomodulator use and decreased steroid dependency.
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