Drug survival and adherence to biologic agents in patients with inflammatory bowel disease from a large health maintenance organization

Abstract

Abstract Background With the increasing use of biologic therapies for the management of inflammatory bowel disease (IBD), it is important to understand their real-world persistence and adherence rates. Aims To assess adherence, drug survival, and risk for discontinuation with biologics in a large cohort of patients with Crohn's disease (CD) and ulcerative colitis (UC) Methods Adult biologic treatment-naive and treatment-experienced patients with CD and UC who initiated treatment with a biologic drug or tofacitinib during 2015–2017 with a large, state-mandated healthcare provider in Israel were included. Adherence and discontinuation rates were recorded. Risk for discontinuation was estimated using the Cox proportional hazard model. Results A total of 889 patients with CD (44.2% female; mean [SD] age, 36.9 [14.2] years; 73.0% biologic-naive) and 255 patients with UC (52.9% female, mean [SD] age, 41.3 [15.6] years; 71.8% biologic-naive) were included. Among patients with CD and UC receiving their first biologic, high adherence was calculated in 75.7% and 80.3%, respectively. Over the course of one year of follow-up, 32.1% of patients with CD and 37.0% of patients with UC discontinued their biologic therapy. In UC, patients receiving vedolizumab were less likely to discontinue treatment compared with those receiving adalimumab, whereas in CD, both treatments were at similar risk for discontinuation. Conclusions Although drug adherence was satisfactory, persistence rates for patients with IBD receiving biologics were suboptimal and varied based on disease, treatment episode, and treatment received.