Abstract
Background
Long-term effectiveness is an important factor when considering treatment decisions.
Objective
To determine the long-term retention patterns of Canadian inflammatory bowel disease (IBD) and rheumatologic disease (RD) patients, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, treated with innovator infliximab (IFX) and to assess the impact of year-over-year cumulative IFX exposure on retention in both patient populations.
Patients and methods
This analysis used a Canadian longitudinal prescription claims database to measure retention on IFX over a period of 5 years. Twelve-month unadjusted odds ratios of retention by time on IFX were calculated for the overall cohort, and within-group comparisons evaluated differences according to age, sex, region, insurance coverage, use of concomitant immunosuppressant therapy, indication (RD cohort only), and previous biologic experience. Between-group analyses compared unadjusted 5-year retention among the same variables. Variables that were independently associated with longer retention on IFX were identified using multivariable regression.
Results
Seven thousand eight hundred and six IBD patients and 2,935 RD patients on stable treatment with IFX were included in the analysis. Sixty-nine percent of IBD patients and 66% of RD patients were retained on IFX after 1 year and 33% and 29%, respectively, were retained after 5 years. Moreover, the probability of being retained on IFX significantly increased with cumulative time on IFX. Independent predictors of 5-year retention included sex, region, and type of insurance coverage among IBD patients and region, type of insurance, prior biologic therapy, and specific indication among RD patients. Patients with IBD were 17% more likely to be retained on IFX over 5 years compared to patients with RD.
Conclusion
Real-world Canadian IBD and RD patients on IFX have good overall long-term treatment retention. Previous duration of IFX treatment predicts better future retention, and this knowledge could help inform treatment decisions when patients have been stable on IFX treatment for varying periods of time.
Supplementary materials
Figure S1 Derivation of pair-wise comparisons.
Notes: The equations used to conduct the pair-wise comparisons. Equation 1 was used to calculate the OR. Equation 2 was used to calculate SE which was used in Equation 3 to calculate the 95% CI of the estimated OR. “a” is the number of patients who were retained in the subsequent 12 months, “c” is the number of patients who were retained in the reference year, “b” the number of patients who were not retained in the subsequent 12 months, and “d” is the number of patients who were not retained in the reference year.
Abbreviations: OR, odds ratio; SE, standard error.
Table S1 Unadjusted OR of being retained based on cumulative IFX exposure in subpopulations of IBD patients (OR [95% CI])
Table S2 Unadjusted OR of being retained based on cumulative IFX exposure in subpopulations of RD patients (OR [95% CI])
Acknowledgments
This paper was presented as a poster presentation with interim findings at the following meetings: the European League Against Rheumatism (EULAR) annual meeting in London, England in June 2016 (poster abstract published in Ann Rheum Dis 2016;75(Suppl 2):496–497 and available online at: http://ard.bmj.com/content/75/Suppl_2/496.2); the Canadian Rheumatology Association (CRA) annual meeting in Ottawa, Canada in February 2017 (poster abstract available online at: https://rheum.ca/images/documents/2017_Poster_Presentations_for_JRheum.pdf); the European Crohn’s and Colitis Organization (ECCO) annual meeting in Barcelona, Spain in February 2017 (poster abstract published in J Crohns Colitis 2017;11(Suppl 1) and available online at: https://www.ecco-ibd.eu/publications/congress-abstract-s/abstracts-2017/item/p383-increasing-treatment-time-on-remicadex00ae-infliximab-predicts-subsequent-long-term-retention-in-stable-infliximab-inflammatory-bowel-disease-patients-in-canada-2.html?highlight=WyJtYXJzaGFsbCJd); and the Canadian Digestive Diseases Week (CDDW) annual conference in Banff, Canada in March 2017 (poster abstract available online at: https://www.cag-acg.org/images/cddw/cddw2017_exhibitabstractbook_FINAL.pdf). The authors wish to acknowledge the support of Shoghag Khoudigian-Sinani and Driss Oraichi from IQVIA™ for their support in the design and analysis of this study, as well as Ardeane Healthcare Solutions and medical writer, Christina Clark, for their assistance in the preparation of this paper.
Disclosure
This study was funded in full by Janssen Inc. Writing support was provided by Ardeane Healthcare Solutions and funded by Janssen Inc. Philip Baer has received consultant and speaking fees of <$10,000 from Amgen, Novartis, AbbVie, Johnson & Johnson, Takeda, LifeLabs, Paladin, Sanofi-Genzyme, SOBI, Merck, and Roche; consultant fees of >$10,000 from Eli Lilly; and consultant and speaking fees of >$10,000 from Janssen and Pfizer. Guy Aumais has received consultancy/advisory fees from Janssen, AbbVie, Takeda, Shire, Ferring, and Allergan and has received research funding from Pfizer, Janssen, Genentech, Celgene, and Shire. Emanuel M Ewara and A Marilise Marrache are employees of Janssen Inc. Majed Khraishi has received consultant or speaking fees and/or honoraria of <$10,000 from Janssen, Pfizer, and AbbVie. Remo Panaccione has received consultancy and/or speaker and/or advisory fees from AbbVie, Abbott, Amgen, Aptalis, AstraZeneca, Baxter, BMS, Celgene, Centocor, Cubist, Elan, Eisai, Ferring, Gilead, GlaxoSmithKline, Genentech, Janssen, Merck, Pfizer, Prometheus, Robarts, Salix, Samsung, Schering-Plough, Shire, Takeda, and UCB and research funding from AbbVie, Abbott, Ferring, Janssen, and Takeda. John Wade has received consultancies, speaking fees, and/or honoraria of <$10,000 from Amgen, Abbvie, Janssen, Novartis, Roche, BMS, Sanofi, and Celgene. John K Marshall has received speaking and/or consultancy fees from AbbVie, Allergan, AstraZeneca, Boehringer-Ingelheim, Celgene, Celltrion, Ferring, Hospira, Janssen, Lilly, Merck, Pfizer, Pharmascience, Procter & Gamble, Shire, and Takeda. The authors report no other conflicts of interest in this work.
Author contributions
All authors met the ICMJE criteria and all those who fulfilled these criteria are listed as authors. PAB, GA, MK, JKM, RP, and JW contributed to research design, data interpretation, revising the article critically, and approving the final version of the manuscript. EME and AMM contributed to research design, data collection and interpretation, revising the article critically, and approving the final version of the manuscript. All authors had full access to data while writing the paper. All authors accept accountability for all aspects of the work including accuracy and integrity.