Treatment sequencing patterns and healthcare resource utilization in patients with Crohn’s disease initiating biologics: a 3-year retrospective claims-based analysis

Abstract

Objective: This study aimed to provide a comprehensive analysis of long-term treatment patterns, biologic treatment sequencing, healthcare resource utilization (HCRU), and costs in biologic-naïve patients with CD. Methods: This retrospective analysis utilized data from the IQVIA PharMetrics Plus claims database (2014–2022), representative of the United States (US) commercially insured population under 65 years. Biologic-naïve adults (≥18 years) with CD were included if they had ≥12 months of continuous enrollment before and after initiating Food and Drug Administration (FDA)-approved biologics (2015–2021). Outcomes included treatment persistence, switching, dose escalation, augmentation, and HCRU over 12–36 months of follow-up. Dose escalation and augmentation were defined based on therapy adjustments or concurrent use of conventional treatments. Descriptive and Kaplan-Meier analyses were conducted using SAS 9.4 to evaluate treatment patterns and outcomes. Results: Of 390,396 patients with a qualifying claim during the index period, 7,353 biologic-naïve patients with CD met the inclusion criteria. The cohort had a mean age of 39.2 (standard deviation [SD] = 13.8) years, 51.4% were female, and 97.2% had commercial insurance. Follow-up averaged 32.5 (SD = 17.2) months, with 59.5% having ≥24 months of follow-up. Adalimumab (50.6%) and infliximab (26.9%) were the most common first-line therapies. Ustekinumab as first-line therapy showed numerically highest persistence (12 months: 79.0%; 24 months: 69.9%) and highest dose escalation rates among biologics. Median time to augmentation was 1.5 months for first-line therapies. Total CD-related costs per year varied across therapy groups, with ustekinumab having the numerically highest costs ($135,311 [SD = 69,162]). Conclusion: This analysis reveals variability in biologic treatment patterns. Most biologic-naïve patients start with anti-TNFs, even though other therapies show numerically higher persistence than anti-TNFs, highlighting the need for effective treatment sequencing and monitoring. Rising healthcare costs emphasize strategic decisions for effective biologics and efficient resource allocation in real-world settings.