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Tepeš K, Hanžel J, Štubljar D, Strmšek K, Erjavec L, Supovec E, Jagodic Z, Končan M, Grosek J, Košir JA, Tomažič A, Kogovšek U, Norčič G, Šibli R, Žnidaršič M, Pačnik Vižintin T, Sodin B, Breznik J, Hribar VA, Ocepek A, Pernat Drobež C, Bukovnik N, Zafošnik A, Marušič T, Jurečič Brglez N, Denkovski M, Smrekar N, Novak G, Koželj M, Kurent T, Simonič J, Pintar Š, Štabuc B, Drobne D. Biological treatment approach to inflammatory bowel disease is similar in academic and nonacademic centres - prime time for decentralisation of inflammatory bowel disease care? Eur J Gastroenterol Hepatol 2024; 36:728-734. [PMID: 38625825 PMCID: PMC11045401 DOI: 10.1097/meg.0000000000002771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/08/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND With the increasing number of inflammatory bowel disease (IBD) patients, it is difficult to manage them within specialised IBD teams in academic medical centres: many are therefore treated in nonacademic IBD centres. It is unclear whether the time to introducing biologics is the same in both settings. AIM We aimed to compare treatment approach with biologics in academic vs. nonacademic centres. METHODS We analysed Slovenian national IBD registry data (UR-CARE Registry, supported by the European Crohn's and Colitis Organisation), which included 2 academic (2319 patients) and 4 nonacademic IBD (429 patients) centres. RESULTS The disease phenotype was similar in both settings. In total, 1687 patients received 2782 treatment episodes with biologics. We observed no differences in treatment episodes with TNF-alpha inhibitors (60% vs. 61%), vedolizumab (24% vs. 23%), or ustekinumab (17% vs. 16%) in academic compared to nonacademic centres ( P = 0.949). However, TNF inhibitors were less often the first biologic in academic centres (TNF inhibitors: 67.5% vs. 74.0%, vedolizumab: 20.3% vs. 17.9%, ustekinumab: 12.1% vs. 8.1%; P = 0.0096). Consequently, more patients received ustekinumab (29.8% vs. 18.3%) and vedolizumab (17.4% vs. 13.5%) and fewer TNF inhibitors (52.7% vs. 68.2%) for Crohn's disease in academic compared to nonacademic centres, with no such differences for ulcerative colitis. The time to initiation of the first biologic from diagnosis was short and similar in both settings (11.3 vs. 10.4 months, P = 0.2). CONCLUSION In this nationwide registry analysis, we observed that biological treatment choice was similar in academic and nonacademic settings. These findings support the decentralisation of IBD care.
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Affiliation(s)
- Katja Tepeš
- Department of Gastroenterology, General Hospital Celje, Celje
| | - Jurij Hanžel
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - David Štubljar
- In-Medico, Department of Research and Development, Metlika, Slovenia
| | - Karin Strmšek
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Luka Erjavec
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Eva Supovec
- Faculty of Medicine, University of Ljubljana
| | | | | | - Jan Grosek
- Department of Abdominal Surgery, University Medical Centre Ljubljana
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Jurij Aleš Košir
- Department of Abdominal Surgery, University Medical Centre Ljubljana
| | - Aleš Tomažič
- Department of Abdominal Surgery, University Medical Centre Ljubljana
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Urška Kogovšek
- Department of Abdominal Surgery, University Medical Centre Ljubljana
| | - Gregor Norčič
- Department of Abdominal Surgery, University Medical Centre Ljubljana
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Renata Šibli
- Department of Gastroenterology, General Hospital Celje, Celje
| | | | | | - Barbara Sodin
- Department of Gastroenterology, General Hospital Celje, Celje
| | - Janez Breznik
- Department of Gastroenterology, General Hospital Jesenice, Jesenice
| | | | - Andreja Ocepek
- Department of Gastroenterology, University Medical Centre Maribor, Maribor
| | | | - Nejc Bukovnik
- Department of Gastroenterology, University Medical Centre Maribor, Maribor
| | - Andrej Zafošnik
- Department of Gastroenterology, University Medical Centre Maribor, Maribor
| | - Tamara Marušič
- Department of Gastroenterology, General Hospital Izola, Izola
| | | | | | - Nataša Smrekar
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Gregor Novak
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Matic Koželj
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Tina Kurent
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Jože Simonič
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Špela Pintar
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Borut Štabuc
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
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Kapizioni C, Desoki R, Lam D, Balendran K, Al-Sulais E, Subramanian S, Rimmer JE, De La Revilla Negro J, Pavey H, Pele L, Brooks J, Moran GW, Irving PM, Limdi JK, Lamb CA, Parkes M, Raine T. Biologic therapy for inflammatory bowel disease: Real-world comparative effectiveness and impact of drug sequencing in 13,222 patients within the UK IBD BioResource. J Crohns Colitis 2023:jjad203. [PMID: 38041850 DOI: 10.1093/ecco-jcc/jjad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND AND AIMS To compare effectiveness of different biologic therapies and sequences in patients with Inflammatory Bowel Disease (IBD) using real-world data from a large cohort with long exposure. METHODS Demographic, disease, treatment and outcome data were retrieved for patients in the UK IBD BioResource. Effectiveness of treatment was based on persistence free of discontinuation or failure, analysed by Kaplan-Meier survival analysis with inverse probability of treatment weighting to adjust for differences between groups. RESULTS 13,222 evaluable patients received at least one biologic. In ulcerative colitis (UC) first line vedolizumab (VDZ) demonstrated superior effectiveness over five years compared to anti-TNF agents (p=0.006). VDZ was superior to both infliximab (IFX) and adalimumab (ADA) after ADA and IFX failure respectively (p<0.001 and p<0.001). Anti-TNF therapy showed similar effectiveness when used first-line, or after failure of VDZ. In Crohn's disease (CD) we found significant differences between first line treatments over ten years (p=0.045), with superior effectiveness of IFX compared to ADA in perianal CD. Non-anti-TNF biologics were superior to a second anti-TNF after first line anti-TNF failure in CD (p=0.035). Patients with UC or CD experiencing TNF-failure due to delayed loss of response or intolerance had superior outcomes when switching to a non-anti-TNF biologic, rather than a second anti-TNF. CONCLUSIONS We provide real-world evidence to guide biologic selection and sequencing in a range of common scenarios. Our findings challenge current guidelines regarding drug selection after loss of response to first anti-TNF.
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Affiliation(s)
- Christina Kapizioni
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Gastroenterology, Attikon University Hospital, Athens, Greece
| | - Rofaida Desoki
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Genetics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Danielle Lam
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Karthiha Balendran
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Clinical Medicine, University of Jaffna, Sri Lanka
| | - Eman Al-Sulais
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Sreedhar Subramanian
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joanna E Rimmer
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Medical Directorate, Joint Medical Command, Birmingham Research Park, Birmingham, UK
| | - Juan De La Revilla Negro
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Holly Pavey
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
- Institute of Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Laetitia Pele
- Department of Medicine, University of Cambridge, UK
- IBD BioResource, NIHR BioResource, Cambridge, UK
| | - Johanne Brooks
- Department of Clinical Pharmacology and Biological Sciences, University of Hertfordshire, Hatfield, UK
- Gastroenterology Department, Lister Hospital, Stevenage, UK
| | - Gordon W Moran
- University of Nottingham, NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Jimmy K Limdi
- IBD Section- Northern Care Alliance NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine & Health,University of Manchester
| | - Christopher A Lamb
- Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Miles Parkes
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Cichewicz A, Tencer T, Gupte-Singh K, Egodage S, Burnett H, Kumar J. A Systematic Review of the Economic and Health-Related Quality of Life Impact of Advanced Therapies Used to Treat Moderate-to-Severe Ulcerative Colitis. Adv Ther 2023; 40:2116-2146. [PMID: 37000363 PMCID: PMC10130125 DOI: 10.1007/s12325-023-02488-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION The clinical benefits of advanced therapies (i.e., biologics and small-molecule drugs) in the treatment of moderate-to-severe ulcerative colitis (UC) have been demonstrated; however, there is less clarity regarding the economic and health-related quality of life (HRQoL) impact of these treatments. We conducted a systematic literature review to synthesize data on cost, healthcare resource utilization (HCRU), and HRQoL for patients who received approved advanced therapies for moderate-to-severe UC in the United States and Europe. METHODS Databases including MEDLINE, Embase, the Database of Abstracts of Reviews of Effects (DARE), the National Health Service Economic Evaluation Database (NHS EED), and EconLit were searched systematically to identify observational studies published between January 1, 2010 and October 14, 2021 that assessed the impact of advanced therapies on cost, HCRU, and/or HRQoL in adults with moderate-to-severe UC. Supplementary gray literature searches of conference proceedings from the past 4 years (January 2018 to October 2021) were also performed. RESULTS 47 publications of 40 unique cost/HCRU studies and 13 publications of nine unique HRQoL studies were included. Findings demonstrated that biologics have a positive impact on indirect costs (i.e., productivity, presenteeism, and absenteeism) and HRQoL. High costs of biologics were not always fully offset by reductions in cost and HCRU associated with disease management. For many patients, treatment switching and dose escalations were required, thus increasing drug costs, particularly when switching across treatment classes. CONCLUSION These findings highlight a high unmet need for therapies for moderate-to-severe UC that can reduce the healthcare burden and impact on society. Further research is warranted, as the reported evidence was limited by the small sample sizes of some treatment groups within a study.
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Affiliation(s)
| | - Tom Tencer
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | - Sonya Egodage
- Evidera, 500 Totten Pond Rd, Waltham, MA, 02451, USA
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