Impact of Adalimumab Patient Support Program's Care Coach Calls on Clinical Outcomes in Patients with Crohn's Disease in Canada: An Observational Retrospective Cohort Study

Abstract

Background: Adalimumab is an antitumour necrosis factor (TNFα) biologic therapy indicated for the treatment of Crohn's disease (CD). Patients receiving adalimumab in Canada are eligible to enroll in the AbbVie Care™ patient support program (AC-PSP), which provides personalized services, including care coach calls (CCCs). The objective of this study was to compare the likelihood of achieving clinical remission in a cohort of CD patients treated with adalimumab who did and did not receive CCCs.

Methods: A longitudinal analysis was performed using de-identified aggregate-level data collected through the AC-PSP. Patients were indexed on the date of their first injection of adalimumab between July 2010 and October 2014. The AC-PSP database included measurements of the Harvey-Bradshaw Index (HBI), a symptom-based measure of disease severity. Eligible patients had an initial HBI measurement performed between 90 days before and up to 30 days after the index date and a follow-up HBI measurement six to 18 months later. Adjusted relative risk (RR) of achieving remission (HBI ≤ 4) at the time of the follow-up was estimated comparing patients who received and did not receive CCCs.

Results: There were 381 CD patients who met eligibility criteria; 224 (59%) received CCCs, and 157 (41%) did not receive CCCs. Multivariate regression analysis demonstrated that CD patients receiving CCCs had a 17% increased likelihood of achieving HBI remission when compared with patients who did not receive CCCs (RR = 1.17; 95% CI, 1.03-1.34; P = 0.0192).

Conclusions: This study provides preliminary evidence that a phone call intervention, aiming to improve the overall patient experience with adalimumab treatment, may increase the likelihood of HBI remission in patients taking adalimumab to manage CD.

Keywords: Adalimumab; Biologics; Crohn’s disease; Inflammatory bowel disease; Patient support programs.

Figure 1.

Patient selection criteria. Patients were selected for study inclusion if they had their first HBI assessment made during a period starting 90 days before and ending 30 days after the initial injection of adalimumab and had a follow-up HBI assessment made in a period beginning 180 days after and ending 545 days (six to 18 months) after the first injection date. Abbreviations: HBI, Harvey-Bradshaw Index; CCC, Coach Care Call

Figure 2.

All Crohn’s disease patient selection results. Abbreviations: CD, Crohn’s disease; HBI, Harvey-Bradshaw Index; PSP, patient support program; index date, date of first adalimumab injection; CCC, care coach call. *2259 of 6724 Crohn’s disease patients could be linked between the AbbVie Care PSP and IQVIA LRx databases using a probabilistic matching algorithm described in a prior publication (9).