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Treatment Patterns Among Patients With Crohn's Disease and Ulcerative Colitis
TAKE-HOME MESSAGE
- This study assessed treatment patterns among patients with Crohn's disease and ulcerative colitis. Despite updated treatment recommendations, only a few patients with newly diagnosed Crohn's disease or ulcerative colitis initiated advanced therapy. Many patients cycled through multiple conventional therapies, predominantly treatment with corticosteroids, before starting advanced therapies.
- There is significant room to improve treatment strategies for induction and maintenance of remission in patients with moderate to severe IBD. Strategies to overcome barriers in clinical practice are needed.
abstract
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Crohn's & Colitis 360
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Treatment Pathways in Patients With Crohn's Disease and Ulcerative Colitis: Understanding the Road to Advanced Therapy
Crohns Colitis 360 2024 Jul 01;6(3)otae040, CA Siegel, D Sharma, J Griffith, Q Doan, S Xuan, L MalterFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In recent years, more advanced therapies (AT) have been developed for Crohn's disease (CD) and ulcerative colitis (UC), demonstrating both efficacy and favorable safety profiles. More data continue to demonstrate the importance of disease control to prevent disease-related complications. Recommendations advocate for early AT, particularly in CD, or moderate-to-severe UC; however, the real-world uptake of these treatment strategies is poorly understood.
Using the Merative MarketScan claims database from 2017 to 2021, Siegel et al insightfully assessed treatment patterns among both newly diagnosed patients with IBD and those initiating an AT. The study compellingly highlights a significant underutilization of AT in modern IBD care. Among newly diagnosed patients, only 14.4% of those with CD and 5.9% of those with UC were started on AT during a mean follow-up duration of 2.3 years. Additionally, among those eventually starting AT, most patients experienced a convoluted and redundant path with an average of four cycles of conventional therapy. The reliance on steroids was compelling, with 80.4% of patients with CD and 76.6% of patients with UC receiving only corticosteroid monotherapy at diagnosis, between 50% and 65% reporting multiple corticosteroid courses, and a cumulative steroid exposure of over 4 months before initiating AT.
This study highlights a disheartening and sobering reality in IBD management — many patients continue to be treated with steroids and conventional therapies despite modern steroid-sparing therapies with improved effectiveness and safety profiles. Delays in starting AT for IBD, particularly CD, can lead to excessive corticosteroid exposure with all associated risks, disease-related complications, hospitalizations, surgeries, and increased healthcare costs. Although many barriers may exist including provider, patient, practice, and insurance factors to impede AT access, providers should strive to identify and overcome these obstacles in an effort to optimize clinical outcomes for patients with IBD.