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. 2021 Mar 17;21(1):121.
doi: 10.1186/s12876-021-01708-6.

Understanding patient journey in ulcerative colitis prior to biologic initiation: a 5-year exploration

Yiting Wang  1 , Rupa Makadia  2 , Christopher Knoll  2 , Jill Hardin  2 , Erica A Voss  2 , Daniel Fife  2 , Kourtney Davis  2 , Sheldon Sloan  3
Affiliations

Understanding patient journey in ulcerative colitis prior to biologic initiation: a 5-year exploration

Yiting Wang et al. BMC Gastroenterol. .

Abstract

Background: There has been a more pronounced shift toward earlier, more aggressive therapies in Crohn's disease than in ulcerative colitis (UC). The aim of this study was to describe the pre-biologic treatment and health care experience, including co-morbidities and overall health care utilization, for UC patients who initiated biologic therapies, in the 5 years prior to the initiation of the first biologic agent.

Methods: UC patients who initiated a biologic agent approved for UC between 9/15/2005 and 1/30/2018 were identified from the IBM® MarketScan® Commercial Database, a large US database. The date of the first recorded UC biologic exposure was defined as the index date, and ≥ 5 years of pre-index records were required to evaluate patients' treatment, disease progression and overall health care utilization prior to initiating biologic agents.

Results: Among the 1891 eligible patients, treatment with oral corticosteroids, 5-aminosalicylates, and other non-biologic immunomodulators, all increased progressively across the 5 years prior to the index. From within year-five to within year-one prior to the index, the median duration of oral corticosteroid treatment increased from 34 to 88 days per year and the proportion of patients who experienced more extensive/pancolitis disease increased from 16 to 59%. Overall, the frequency of all-cause health care visits also increased.

Conclusions: Patients with UC experienced increasing morbidity and treatment burden in the 5 years prior to initiating biologic therapy. To achieve reduced corticosteroids in UC management, better risk stratification is needed to help identify patients for more timely biologic treatment.

Keywords: Biologic initiation; Corticosteroid exposure; Ulcerative colitis.

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Conflict of interest statement

YW, RM, CK, JH, EV, DF, KD, are full-time employees of Janssen R&D, LLC, a unit of Johnson & Johnson. At the time of this work, SS was employed by Janssen Global Services, LLC, a unit of Johnson & Johnson. The work on this study was part of their employment. They also hold pension rights from the company and own stock and stock options.

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