S1153 Treatment Utilization and Sequencing in Patients With Ulcerative Colitis and Crohn's Disease
Bibliographic record
Abstract
Introduction: Ulcerative colitis (UC) and Crohn’s disease (CD), collectively referred to as inflammatory bowel disease (IBD), are chronic disorders of the gastrointestinal tract typically marked by remission and relapse.1 Recently new therapies have become available to treat IBD though there is a paucity of data on their use in practice. This study assessed treatment sequencing in patients with UC & CD newly initiated on advanced therapies (AT) or immunosuppressants (IMS). Methods: This retrospective US claims database (Merative™ Marketscan®) study assessed treatment sequencing over a 24-month period in adults with UC & CD newly initiated on an AT or IMS therapy between January 1, 2017-March 31, 2021. FDA-approved therapies through March 2021 were included. Index date was defined as the first prescription date of AT or IMS. Patients were required to be continuously enrolled for at least 12-months pre-index (baseline period) and 24-months post-index (follow-up period). Descriptive statistics were used to assess baseline characteristics & follow-up treatment sequences. Results: Of the 10,585 IBD patients identified, 4651 had UC & 5934 had CD. Baseline characteristics are described in Table 1. Among AT initiators (UC: 3076; CD: 4043), 79% UC & 84% CD patients received AT-only; the remainder received AT + corticosteroids (CS) and/or IMS. Of the AT initiators, ∼47% UC & ∼40% CD patients received subsequent second-line therapy (Figure 1). Among IMS initiators (UC: 1575; CD: 1891), 58% UC & 62% CD patients were treated with IMS-only; the remainder on IMS+CS and/or AT. Almost 80% UC & 79% CD IMS initiators received subsequent second-line therapy (Figure 1). Conclusion: Whilst there is an armamentarium of options available to treat UC & CD, this real-world study shows that regardless of AT or IMS, many patients receive combination and/or multiple lines of therapy, as previously reported.2 This highlights that a substantial unmet need for a durable, effective, and tolerable treatment option persists. References 1. Wang R, et al. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019. BMJ Open 2023;13:e065186. 2. Triantafillidis JK, et al. Combination treatment of inflammatory bowel disease: Present status and future perspectives. World J Gastroenterol. 2024 Apr 21;30(15):2068-2080. Disclosures: The study was funded by Teva Pharmaceuticals; publication supported by Teva-Sanofi Alliance.Figure 1.: Second-line treatment regimens. Table 1. - Baseline Characteristics AT Initiatorsa IMS Initiatorsb UC (n=3076) CD (n=4043) UC (n=1575) CD (n=1891) Age Mean (SD) 42 (13.8) 41 (13.8) 43 (13.6) 41 (13.5) Median (IQR) 42 (22.0) 41 (22.0) 43 (22.0) 42 (22.0) Min, Max 18, 86 18, 89 18, 91 18, 91 Sex (n, %) Female 1468 (47.7) 2163 (53.5) 815 (51.7) 1033 (54.6) Male 1608 (52.3) 1880 (46.5) 760 (48.3) 858 (45.4) Region (n, %) North Central 783 (25.5) 1066 (26.4) 424 (26.9) 511 (27.0) Northeast 473 (15.4) 599 (14.8) 231 (14.7) 233 (12.3) South 1427 (46.4) 1907 (47.2) 681 (43.2) 894 (47.3) West 390 (12.7) 463 (11.5) 234 (14.9) 252 (13.3) Unknown 3 (0.1) 8 (0.2) 5 (0.3) 1 (0.1) Index year (n, %) 2017 736 (23.9) 997 (24.7) 505 (32.1) 555 (29.3) 2018 687 (22.3) 980 (24.2) 383 (24.3) 468 (24.7) 2019 753 (24.5) 984 (24.3) 345 (21.9) 431 (22.8) 2020 715 (23.2) 837 (20.7) 275 (17.5) 349 (18.5) 2021 185 (6.0) 245 (6.1) 67 (4.3) 88 (4.7) aTreatments include: adalimumab, certolizumab, infliximab, natalizumab, ustekinumab, golimumab, vedolizumab, tofacitinib.bTreatments include: 6-mercaptopurine, azathioprine, methotrexate, cyclosporine, tacrolimus.AT, advanced therapies; CD, Crohn's disease; IMS, immunosuppressants; IQR, interquartile range; SD, standard deviation; UC, ulcerative colitis.
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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 | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".