The introduction of Remicade as a therapy for Crohn’s disease and ulcerative colitis has not reduced the rate of disease-related hospitalization or intestinal surgery as much as was anticipated, according to data published in Gut.
Sanjay K. Murthy, MD, FRCPC, MSc, of the University of Ottawa, and colleagues wrote that anti-TNFs like Remicade (infliximab, Janssen) have made major impact on IBD care but come with a price, becoming the biggest expenditure among patients with IBD.
“The extent to which biologic agents offset these costs by reducing the costly and burdensome outcomes of hospitalizations and surgeries among patients with IBD in the real-world remains unknown,” they wrote. “In clinical practice, there is likely much greater variability in patient selection, treatment application and patient monitoring than in RCTs, which may significantly reduce treatment effectiveness at a population-level.”
To explore the effect of infliximab introduction on population rates of hospitalizations and surgeries, as well as public payer costs, researchers performed an interrupted time series study using administrative data from patients with CD and UC living in Ontario, Canada between 1995 and 2012. Among patients with CD, they looked at the impact over 10 years, while looking at 5 years for patients with UC.
Compared with what would have been expected in the absence of the drug, researchers found that marketplace introduction did not produce significant declines in the rates of CD-related hospitalizations (OR at the last observation quarter = 1.06; 95% CI, 0.811–1.39) or intestinal resections (OR = 1.1; 95% CI, 0.81–1.5). The findings were similar among patients with UC for hospitalizations (OR = 1.22; 95% CI, 1.07–1.39) and colectomies (OR = 0.933; 95% CI, 0.54–1.61).
Among patients with UC who received publicly funded infliximab, investigators saw a reduction in hospitalization rates (OR = 0.515; 95% CI, 0.342–0.777). Patients with CD who received publicly funded infliximab did not experience changes in rates of disease-related hospitalizations or surgery.
Investigators observed a rise over expected trends in the public payer drug costs among patients with CD (OR = 2.98; 95% CI, 2.29–3.86), which they wrote suggested good market penetration for the drug in this population. However, they saw no significant change in costs among patients with UC.
Murthy and colleagues called their findings, particularly among patients with CD, “surprising,” considering the success of infliximab in randomized controlled trials. They called for future studies to explore the specific reason for lack of decline and other impacts of infliximab therapy.
“Real-world experience has substantiated the clinical trial experience that infliximab is an effective therapy for improving symptoms and inducing mucosal healing in CD,” they wrote. “We hypothesize that misguided use and failure to optimize infliximab in many patients with CD, as well as underuse of this agent among patients with UC, may largely explain the underperformance of this treatment in the clinical practice setting.” – by Alex Young
Disclosures: Murthy reports receiving honoraria for speaking or consulting from AbbVie, Ferring, Janssen, Pfizer, Shire and Takeda. Please see the full study for all other authors’ relevant financial disclosures.