Anti-tumor necrosis factor agents reduce corticosteroid use compared with azathioprine in patients with Crohn’s disease

Abstract

Background:

Corticosteroids are effective for inducing remission of Crohn’s disease, but should not be used long term due to risk of adverse events. Benefits of immunosuppressants (e.g., azathioprine) and anti tumor necrosis factor (anti-TNF) agents include reduced reliance on corticosteroid-based therapies and avoidance of corticosteroid-associated adverse events. Our aim was to evaluate corticosteroid-sparing effects in patients with Crohn’s disease upon being newly initiated on an anti-TNFα agent or azathioprine.

Methods:

An analysis of US patient claims data from January 2008 to October 2011 was conducted using Truven Health MarketScan Research databases. Corticosteroid-sparing within 12 and 24 months after initiation of an anti-TNF agent (adalimumab, certolizumab pegol, or infliximab) or azathioprine was evaluated.

Results:

In total, 2900 patients received a prescription for corticosteroids within the 6 month period before the initiation of an anti-TNF agent (63%) or azathioprine (37%). When certolizumab pegol, infliximab, or adalimumab were collectively compared with azathioprine, patients initiated on an anti-TNF agent avoided further prescriptions for corticosteroids at a greater rate than patients receiving azathioprine at 12 (43% vs. 27%, respectively; P < 0.0001) and 24 months (33% vs. 23%, respectively; P = 0.028). Individually, all anti-TNF agents showed higher rates of corticosteroid-sparing compared with azathioprine at 12 (P < 0.0001–0.011), but not 24 months (P = 0.0086–0.24). Key limitations of this study include lack of data regarding disease severity, response and assumptions of improvement, and compliance.

Conclusions:

Patients with Crohn’s disease were able to avoid new prescriptions for corticosteroids at a statistically higher rate when treated with an anti-TNF agent. These results demonstrate that the anti-TNF agents are superior to azathioprine for minimizing exposure to corticosteroids.

Keywords::

• Anti-tumor necrosis factor α
• Corticosteroids
• Crohn’s disease
• Immunosuppressants

Transparency

Declaration of funding

UCB Pharma funded this study.

Declaration of financial/other relationships

S.V.K. has disclosed that she serves as a consultant to AbbVie and UCB and has received research funding from UCB. S.J. and A.V.B. have disclosed that they were employees of UCB Pharma at the time of this study and during manuscript preparation. L.P. has disclosed that she is an employee of Truven Health Analytics, which received compensation for research services associated with this analysis. D.A.S. has disclosed that he serves as a consultant for UCB, AbbVie, Telgenix, Janssen, and Takeda and has received research funding from UCB and AbbVie.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial or other relationships to disclose.

Acknowledgments

This study was funded by UCB Pharma. The authors acknowledge Elizabeth Smith, UCB Pharma, USA for publication management and Katherine Ayling-Rouse of PPSI and Patricia McChesney of Evidence Scientific Solutions for editorial support, which was funded by UCB Pharma.

Previous presentation: Data from this manuscript were presented at the American Academy of Nursing’s 40th Annual Meeting & Conference, 17–19 October 2013, Washington DC, USA; and the American College of Clinical Pharmacy annual meeting, 13–16 October 2013, Albuquerque, NM, USA.

Notes

*Pentasa is a registered trade name of Shire US, Wayne, NJ, USA

^†Asacol is registered trade name of Warner Chilcott, Rockaway, NJ, USA

^‡Rowasa is a registered trade name of Meda Pharmaceuticals, Somerset, NJ, USA

^§Truven Health Market Scan is a registered trade name of Truven Health Analytics, Bethesda, MD, USA