Early administration of anti-tumor necrosis factor (TNF) therapy after diagnosis with Crohn disease (CD) is associated with longer-term decreased health care utilization, according to study findings published in Clinical Gastroenterology and Hepatology.
For the study, researchers sourced data from Manitoba Health patient records collected in Canada between 1984 and 2018. All patients (N=1060) with inflammatory bowel disease (IBD), either with CD (n=742) or ulcerative colitis (UC; n=318), were evaluated for health care utilization 1 to 5 years after commencing anti-TNF therapy. Outcomes were assessed on the basis of initiating anti-TNF therapy early (within 2 years of IBD diagnosis) or late (more than 2 years after diagnosis).
Among the CD cohort, initiating anti-TNF therapy early associated with decreased IBD-specific hospitalization rates during the third (inverse probability treatment weighting [IPTW] adjusted incidence rate difference [aIRD], -5.2; 95% CI, -8.4 to -1.9), fourth (IPTW aIRD, -3.5; 95% CI, -6.8 to -0.1), and fifth (IPTW aIRD, -5.5; 95% CI, -9.1 to -1.8) years of use; IBD-related doctor visits during the second (IPTW aIRD, -142.0; 95% CI, -221.2 to -62.7), third (IPTW aIRD, -153.3; 95% CI, -239.0 to -67.5), and fourth (IPTW aIRD, -144.9; 95% CI, -240.2 to -49.7) years of use; and rates of IBD-specific surgery during the fourth (IPTW aIRD, -4.2; 95% CI, -6.7 to -1.7) and fifth (IPTW aIRD, -5.5; 95% CI, -8.4 to -2.6) years of use.
The early group was associated with significantly lower adjusted mean annual total health care costs at years 3 (mean, $3569 vs $5494; P =.0009), 4 (mean, $27 vs $6111; P <.0001), and 5 (mean, $2967 vs $7372; P <.001) years after initiating anti-TNF therapy.
For the UC group, no group differences were observed on the basis of anti-TNF therapy initiation.
In a subgroup analysis, no group differences for health care utilization were observed on the basis of gender, age, date of anti-TNF treatment initiation, or concomitant treatments among either the CD or UC cohorts.
This study may have been limited, as individuals who commenced anti-TNF therapy earlier may have had more aggressive or complex disease phenotypes.
“…[W]e have demonstrated in a population based setting that early anti-TNF therapy is associated with decreased use of health care services, lower downstream costs, and decreased need for surgical intervention for up to 5 years following treatment initiation (excluding the first year of follow-up),” the study authors wrote. “However, the impact of early intervention in UC is far less clear from our data. We support the performance of further pragmatic trials in UC to determine if protocols which favor the early adoption of biologic therapies and/or highly active small molecules will lead to sustained decreases in meaningful outcomes.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical,
and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Targownik LE, Bernstein CN, Benchimol EI, et al. Earlier anti-TNF initiation leads to long term lower health care utilization in Crohn’s disease but not in ulcerative colitis. Clin Gastroenterol Hepatol. Published online March 2, 2022. doi:10.1016/j.cgh.2022.02.021