The use of biologics to treat inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is established practice. However, real-world evidence on adherence, persistence, switching, and dose escalation with biologics in adult IBD in the US is limited.
How often do patients adhere to prescribed therapies? What are the consequences of adherence and non-adherence?
Researchers from RTI Health Solutions coauthored a systematic literature review sponsored by Janssen Pharmaceuticals. The study was designed to gain a better understanding of rates of adherence, persistence, switching, and dose escalations in the use of biologics to treat IBD. Given the rapidly evolving therapeutic landscape for IBD, this review was limited to studies conducted in the United States and published in the past five years.
Creating meaningful comparisons of data from the identified studies was a challenge, since the methodology, data sources, populations studied, follow-up times, and endpoint definitions used in the studies varied greatly.
Researchers found that up to 25% of patients discontinued biologic therapy in the first three months of treatment, and up to 65% had discontinued by 12 months. While most discontinued treatment because of a lack or loss of response and adverse events, the reasons for discontinuation varied depending on the therapy itself. Adherence rates to biologic therapy varied widely with 38%-77% of patients being non-adherent. Of those who started a biologic, between 8%-35% experienced a dose escalation within the first year, and between 4.5%-20% switched to another biologic.
The research suggests that real-world use of biologics is sub-optimal. Poor adherence to biologic therapy is associated with increased costs for IBD, particularly increased costs related to higher rates of hospitalizations.
Read the full manuscript here:
Khan S, Rupniewska E, Neighbors M, Singer D, Chiarappa J, Obando C. Real-world evidence on adherence, persistence, switching and dose escalation with biologics in adult inflammatory bowel disease in the United States: a systematic review. J Clin Pharm Ther. 2019 Mar 14. doi: 10.1111/jcpt.12830.