S83 Real-World Treatment Persistence Among Advanced Therapy-Experienced Patients With Ulcerative Colitis Initiated on Ustekinumab or Adalimumab
Notice bibliographique
Résumé
Background: Among patients with ulcerative colitis (UC), prior exposure to biologics or advanced therapies is associated with reduced response to future therapies, which may lead to treatment discontinuation. Therapy persistence is a proxy of real-world treatment performance and is important to achieve optimal clinical outcomes. This study compared persistence among advanced therapy-experienced patients with UC initiated on ustekinumab, an anti-interleukin 12/23 antibody, or adalimumab, an anti-tumor necrosis factor biologic. Methods: Adults with UC initiated on ustekinumab or adalimumab (index date) between 10/21/2019 and 03/02/2022 were selected from the IQVIA PharMetrics® Plus database. Patients were advanced therapy-experienced (i.e., had ≥1 claim for a non-index UC-indicated biologic or advanced therapy agent) in the 12-month baseline period before the index date. Patients with other auto-immune diseases during the baseline period were excluded. Cohorts were balanced on baseline characteristics using inverse probability of treatment weights. Persistence was defined as the absence of gaps between days of therapy supply of >120 days for ustekinumab (i.e., twice the 8-week on-label maintenance dosing interval) or >60 days for adalimumab (i.e., twice the mode of days of supply corresponding to 2 doses per the 2-week on-label maintenance dosing interval). Composite endpoints of being persistent while on monotherapy (no immunomodulators, non-index biologics, or advanced therapies) and persistent while corticosteroid-free (< 14 consecutive days of corticosteroid supply after day 90 post-index) were also assessed. All endpoints were evaluated from maintenance phase start until the earlier of 12 months follow-up, end of insurance eligibility or end of data using weighted Kaplan-Meier analyses and weighted Cox proportional hazards models adjusted for the use of ≥2 biologics and class of biologics used during the baseline period. Results: There were 693 patients in the weighted ustekinumab cohort (mean age: 42.6; 45.8% female) and 254 patients in the weighted adalimumab cohort (mean age: 41.6; 46.1% female). At 12 months after the maintenance phase start, 78.1% of the ustekinumab cohort and 59.2% of the adalimumab cohort were persistent on the index biologic; persistence was 2.44 times higher in the ustekinumab cohort relative to the adalimumab cohort (hazard ratio [HR]: 2.44; 95% confidence interval [CI]: 1.82-3.26; p-value: < 0.001). Moreover, 66.7% of the ustekinumab cohort and 40.5% of the adalimumab cohort persisted on the index biologic while on monotherapy; persistence while on monotherapy was 2.53 times higher in the ustekinumab cohort relative to the adalimumab cohort (HR: 2.53; 95% CI: 2.00-3.21; p-value: < 0.001). Finally, 48.0% of the ustekinumab cohort and 42.8% of the adalimumab cohort were persistent while corticosteroid-free; persistence while corticosteroid-free was 1.24 times higher in the ustekinumab cohort relative to the adalimumab cohort (HR: 1.24; 95% CI: 1.01-1.54; p-value 0.0447). Conclusions: Advanced therapy-experienced patients with UC treated with ustekinumab were more persistent, including persistent while on monotherapy and while corticosteroid-free, than patients treated with adalimumab. These findings may aid healthcare providers in choosing a biologic for advanced therapy-experienced patients with UC.
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 | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| 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 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 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 ».