Treatment options for the estimated 700,000 people in the United States, who suffer from Crohn’s disease (CD), include multiple conventional, largely generic small molecules and more-potent biological agents. The American Gastroenterological Association (AGA) guidelines recommend a step-up treatment paradigm that begins with safer (albeit less efficacious) therapies such as the aminosalicylates, before moving on to more-potent therapies, such as corticosteroids (for acute treatment) and immunosuppressants (for maintenance treatment), and finally the biologics. However, some clinicians also use top-down approach (earlier use of biologics). Using national patient-level claims data, this report analyzes physician adherence to the treatment guidelines by exploring the use of key therapies in the newly diagnosed and recently treated CD patient populations. Among the newly diagnosed patients, the report provides a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. Among recently treated patients, the report quantifies a drug’s source of business compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.

Questions Answered in This Report:

  • Newly diagnosed patients: Approximately 40% of CD patients begin treatment with a key therapy within a year of their initial diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?

  • Recently treated patients: Consistent with historical treatment patterns, the oral 5-ASA drug class continues to capture the largest share of recently treated patient prescriptions. Which specific drugs garner the most patient share for recently treated CD patients? When do patients progress from one therapy to the next in CD, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming from new (adds/switches) or continuing business?

  • Pathways to key therapies: Use of TNF-alpha inhibitors and immunosuppressants for CD increases in the later lines of therapy; longitudinal claims data reveal relatively consistent use patterns of key therapies among recently treated patients. Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients? What has been the impact of recently approved drugs for CD?

Scope:

Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet and presents claims that are less than six months old at the time of publication.

Patient Sample:

Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least two claims with a diagnosis code for CD (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 5550) during the study period.

Quantified lines of therapy analyses show exact share of each agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.

Newly Diagnosed Patients:

- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.

- Patient flowchart through one year of treatment for all first-line products, including progression rates and add/switch behavior.

- Polypharmacy and key concomitant therapies by line of therapy.

- Quarterly trends in patient share by line of therapy.

Recently Treated Patients:

- Quarterly snapshot of patient share by drug class and key products.

- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.

- Brand source of business, including share for continuing, new (switches/adds), and new (initial therapy) business.

- Polypharmacy and key concomitant therapies.

- Drug persistence and compliance.

- Quarterly trends in patient share for all key therapies.


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