S801 Long-Term Persistence to Ustekinumab and Adalimumab Among Bio-Naïve Patients With Crohn's Disease
Notice bibliographique
Résumé
Introduction: Persistence on biologics in Crohn’s disease (CD) is an important measure, reflecting real-world treatment effectiveness, safety, and other factors. In the real world among bio-naïve patients with CD, evidence of superior one-year persistence on newer biologics, such as ustekinumab, relative to adalimumab exists, however, an understanding of persistence beyond one year is lacking. Methods: Adults with CD initiated on ustekinumab or adalimumab between 09/23/2016 (approval of ustekinumab for CD in the US) and 08/01/2019 were selected from IBM® MarketScan® Commercial Database. Patients without other CD-indicated biologics (bio-naive) and diagnoses for other autoimmune diseases in the 12 months pre-index date (baseline) were included. No minimal follow-up was imposed post-index date. Persistence on index agent was defined as absence of gaps >120 days (ustekinumab) or >60 days (adalimumab) between days of therapy supply. Composite endpoints of being persistent and corticosteroid-free (no corticosteroids with ≥14 days of supply after day 90 post-index) and persistent while on monotherapy (no immunomodulators or non-index biologics) were also assessed. Cohorts were balanced on baseline characteristics using inverse probability of treatment weights. All endpoints were estimated at 24 months post-index using weighted Kaplan-Meier and Cox's proportional hazards models. Results: There were 671 and 2,975 patients in the ustekinumab and adalimumab cohorts, respectively, and the cohorts were well-balanced at baseline (Table). At 24 months post-index, a significantly higher proportion of patients in the ustekinumab versus adalimumab cohort was persistent on index agent, as well as persistent and corticosteroid-free and persistent while on-monotherapy (Figure). At 24 months in ustekinumab versus adalimumab cohort, the rate of being persistent on index agent was 66% higher (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.40-1.97), the rate of being persistent and corticosteroid-free 15% higher (HR: 1.15; 95% CI: 1.01-1.31), and the rate of being persistent while on-monotherapy 44% higher (HR: 1.44; 95% CI: 1.26-1.64). Conclusion: Bio-naïve patients with CD initiated on ustekinumab versus adalimumab were significantly more persistent, more persistent and corticosteroid-free, and also more persistent while on-monotherapy 24 months after treatment initiation. These results are consistent with those in our previous work at 12 months.Figure 1.: Kaplan-Meier curves of being: a) persistent on index biologic, b) persistent and corticosteroid-free following a 90 days grace period, c) persistent and on monotherapy in weighted ustekinumab and adalimumab cohorts1,2 Notes: 1. Cohorts were weighted on baseline characteristics using inverse probability of treatment weights 2. Rates and log-rank p-values provided at 24 months. Table 1. - Selected baseline characteristics in weighted1 ustekinumab and adalimumab cohorts Mean ± SD or n (%) UstekinumabN=671 AdalimumabN=2,975 Std diff, % Age 41.7 ± 13.3 41.6 ± 13.8 0.8 Female 371 (55.3%) 1,642 (55.2%) 0.2 All-cause costs (US$ 2020) 35,258 ± 57,472 30,104 ± 52,884 9.3 Prescription drug costs 5,095 ± 11,691 5,029 ± 18,564 0.4 Total medical costs 30,163 ± 55,485 25,075 ± 47,187 9.9 Charlson Comorbidity Index 0.60 ± 1.2 0.61 ± 1.1 0.8 CD-related surgery 57 (8.5%) 221 (7.4%) 4.0 Medication Corticosteroids 440 (65.6%) 2,068 (69.5%) 8.4 ≥1 episode with ≥60 days of continuous use 164 (24.4%) 736 (24.8%) 0.7 Immunomodulators 177 (26.4%) 797 (26.8%) 1.0 5-ASA 177 (26.4%) 795 (26.7%) 0.8 Antidiarrheals 51 (7.6%) 204 (6.9%) 2.8 Abbreviations: CD: Crohn’s disease; Std diff: standardized difference; SD: standard deviation; 5-ASA: 5-aminosalicylic acid Notes: (1) Cohorts were weighted on baseline characteristics using inverse probability of treatment weights; characteristics considered well balanced if standardized difference is <10%
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».