(034) The Prescription Pattern of Biologics for Crohn’s Disease Patients in Taiwan

Publication Number: 372

Background: Biologics have been reimbursed for Crohn’s disease (CD) for more than a decade in Taiwan, including restriction treatment duration and retreatment criteria.

Objectives: To determine the real-world prescription pattern of biologics in CD patients.

Methods: This was a retrospective cohort study using Taiwan National Health Insurance Database from 2010 to 2020, enrolled patients newly CD diagnosed, with catastrophic illness certificate, age older than 20 years old, and incident biologics users including adalimumab, infliximab, vedolizumab, and ustekinumab. Utilization patterns were defined as continuing initial biologic, discontinuation (gap was 84 days of two consecutive biologic prescriptions) or switch to another biologic. The treatment course was defined as patients who completed the maintenance phase and meets the criteria of discontinuation. We performed descriptive analysis for prescription pattern and Sankey diagram for switching pattern.

Results: This study enrolled 590 patients, 407 (69.0%) male, mean age (SD) at the first date of CD diagnosis and the biologic prescription was 37.4 (15.5) and 39.8 (15.4) years old, respectively. Median (IQR) lag time from first diagnosis to first biologic prescription was 1.5 (0.6, 3.7) years.
Adalimumab was the most common initial biologic. 343 patients (58.1%) had second treatment course, 188 patients (31.9%) had third course, and 97 patients (16.4%) had fourth course. For treatment transition, after the first course, most patients entered the second course, with 265 (44.9%) using the same biologic and 78 (13.2%) switching. Among those not entering the second course, 129 (21.9%) discontinued biologic, and 118 patients (20.0%) continued their first biologic. The proportion of patients using the same biologic was higher for those treated with adalimumab (80.6%) in the first course compared to vedolizumab (61.5%) and infliximab (57.1%).

Conclusions: This real-world prescription pattern enhances our understanding of biologics in Taiwan’s CD patients. It is an important issue for future research to investigate the optimal treatment course of biologics and to identify patients who may benefit from switching.