S721 Treatment Persistence Among Bio-naïve Patients with Crohn's Disease Initiated on Ustekinumab and Adalimumab
Bibliographic record
Abstract
Introduction: Due to the chronic nature of Crohn’s disease (CD), medication persistence is key to managing symptoms on a sustained basis. This study aimed to compare treatment persistence among bio-naïve patients with CD initiated on ustekinumab or adalimumab. Methods: Adults with CD initiated on ustekinumab or adalimumab between 09/23/2016 (approval of ustekinumab for CD) and 08/01/2019 were selected from a de-identified health insurance claims data from the IQVIA PharMetrics® Plus (01/01/2015-02/01/2020). Patients were excluded if they used other biologics indicated for CD or had diagnoses for rheumatoid or psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, relapsing polychondritis, juvenile idiopathic arthritis, hidradenitis suppurativa or uveitis in the 12 months before the initiation of the index agent (baseline). Cohorts were balanced on baseline characteristics using inverse probability of treatment weights. Persistence on index agent was defined as absence of gaps >120 days (ustekinumab) or >60 days (adalimumab) between days of therapy supply. Additionally, composite endpoints of being persistent on index biologic and corticosteroid-free (< 14 days of supply after day 90 post-index) and persistent and on monotherapy (no immunomodulators or non-index biologics) were assessed. All endpoints were estimated at 12 months post-index using weighted Kaplan-Meier and Cox's proportional hazards model analyses. Results: There were 948 patients in the ustekinumab and 4,143 patients in the adalimumab cohort; baseline characteristics were balanced in weighted cohorts (Table 1). At 12 months post-index, a higher proportion of patients in the ustekinumab vs adalimumab cohort was persistent on index biologic, including persistent and corticosteroid-free, and persistent and on monotherapy (Figure 1; log-rank all p< 0.05). Patients in the ustekinumab vs adalimumab cohort had a 50% higher rate of persistence on index biologic (hazard ratio [HR] 1.50; 95% confidence interval [CI]: 1.29-1.74), 17% higher rate of being persistent and corticosteroid-free (HR: 1.17; 95% CI: 1.04-1.31), and 47% higher rate of being persistent and on monotherapy (HR: 1.47; 95% CI: 1.30-1.65). Conclusion: Bio-naïve patients with CD initiated on ustekinumab were more persistent than patients initiated on adalimumab, including being persistent and corticosteroid-free and being persistent and on monotherapy. These results may help inform biologic choice for bio-naïve patients with CD.Table 1.: Adjusted hazard ratio of therapeutic modification for primary and secondary outcomes.Figure 1.: Impact of Tofacitinib on Disease Activity Scores.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".