Objective: This study examined biologic treatment patterns among Crohn’s Disease (CD)-related patients initiating biologics over a 3-year follow-up period.

Methods: This descriptive study used All Payers Claims Data (APCD) from Sep 2015 to Oct 2021. Adult patients with ≥1 CD medical claim and ≥1 medical/pharmacy claim for a biologic (adalimumab [ADA], certolizumab pegol [CZP], infliximab [IFX] and its biosimilar products [IFX-BS], ustekinumab [UST], and vedolizumab [VDZ]) during Sep 2016 to Oct 2018 were selected. Index date was the first biologic claim date. Patients had continuous capture with commercial insurance for ≥12 months pre (baseline) and ≥36 months post index date (follow-up).  Using a claims-based algorithm, confirmed CD patients were included in the final cohort. A persistent patient was one that remained on the index biologic without a gap of >60 days for ADA and CZP, and of >120 days for UST, IFX, IFX-BS, and VDZ between run-out dates of two sequential biologic claims. Patients who discontinued were classified as switchers (to another biologic), restarters (restarted index biologic), or discontinuers without switch and restart during follow-up.

Results: A total of 2,309 CD patients were identified (394 [17.1%] UST, 847 [36.7%] IFX, 72 [3.1%] IFX-BS, 534 [23.1%] ADA, 85 [3.7%] CZP, and 486 [21.1%] VDZ). Due to a small sample size, CZP and IFX-BS groups were excluded in further analyses. Approximately half of the CD patients were between age 35 to 54. Patients on UST and VDZ had numerically higher Charlson comorbidity index score at baseline. Common comorbidities among CD patients at baseline included anemia, anxiety, depression, fatigue, and hypertension. UST (61.4%) patients had the highest persistence rate numerically in year 3 after treatment initiation, followed by VDZ (58.0%), ADA (52.1%), and IFX (48.1%). Numerically, UST (18.8%) had the lowest switch rate, followed by VDZ (24.5%), ADA (26.6%), and IFX (32.9%).

Conclusions: UST had the highest persistence and lowest switch rate numerically in year 3 after treatment initiation among patients with CD.

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