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McCallion J, Borsi A, Noel W, Lee J, Karmous W, Sattler S, Boggia GM, Hardy EJ, Mitchell CR, Mitchell SA, Gilhus NE. Systematic review of the patient burden of generalised myasthenia gravis in Europe, the Middle East, and Africa. BMC Neurol 2024; 24:61. [PMID: 38336636 PMCID: PMC10858594 DOI: 10.1186/s12883-024-03553-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Myasthenia gravis (MG) is a rare autoimmune disease characterised by muscle weakness, and progression from ocular (oMG) to generalised (gMG) symptoms results in a substantial negative impact on quality of life (QoL). This systematic review aimed to provide an overview of the patient burden experienced by people living with gMG. METHODS Electronic database searches (conducted March 2022), supplemented by interrogation of grey literature, were conducted to identify studies reporting patient burden outcomes in patients with gMG in Europe, the Middle East and Africa. Results were synthesised narratively due to the heterogeneity across trials. RESULTS In total, 39 patient burden publications (representing 38 unique studies) were identified as relevant for inclusion in the systematic review, consisting of 37 publications reporting formal patient-reported outcome measures (PROMs), and two publications describing alternative qualitative assessments of patient experience. The studies included a variety of measures including generic and disease-specific PROMs, as well as symptom-specific PROMs focusing on key comorbidities including depression, anxiety, fatigue and sleep disturbance. The findings showed some variation across studies and PROMs; however, in general there was evidence for worse QoL in patients with gMG than in healthy controls or in patients with oMG, and a trend for worsening QoL with increasing MG severity. CONCLUSIONS This review highlights the importance of considering patient QoL when developing and assessing treatment and management plans for patients with gMG. However, the heterogeneity identified across studies illustrates the need for further representative and well-powered studies in large cohorts administering consistent, validated questionnaires. TRIAL REGISTRATION The protocol for this systematic review was registered in PROSPERO: CRD42022328444.
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Affiliation(s)
| | - A Borsi
- Janssen EMEA, Beerse, Belgium
| | - W Noel
- Janssen EMEA, Beerse, Belgium
| | - J Lee
- Janssen EMEA, Beerse, Belgium
| | | | | | | | - E J Hardy
- Mtech Access, Bicester, Oxfordshire, UK
| | | | | | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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Zhuleku E, Antolin-Fontes B, Borsi A, Nissinen R, Bravatà I, Barthelmes JN, Lee J, Passey A, Wirth D, Maywald U, Bokemeyer B, Wilke T, Ghiani M. Burden of disease among patients with prevalent Crohn's disease: results from a large German sickness fund. Int J Colorectal Dis 2023; 38:74. [PMID: 36939923 PMCID: PMC10027629 DOI: 10.1007/s00384-023-04368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The aim of this study was to investigate the burden of disease among a real-world cohort of patients with prevalent Crohn's disease (CD) in Germany. METHODS We conducted a retrospective cohort analysis using administrative claims data from the German AOK PLUS health insurance fund. Continuously insured patients with a CD diagnosis between 01 October 2014 and 31 December 2018 were selected and followed for at least 12 months or longer until death or end of data availability on 31 December 2019. Medication use (biologics, immunosuppressants (IMS), steroids, 5-aminosalicylic acid) was assessed sequentially in the follow-up period. Among patients with no IMS or biologics (advanced therapy), we investigated indicators of active disease and corticosteroid use. RESULTS Overall, 9284 prevalent CD patients were identified. Within the study period, 14.7% of CD patients were treated with biologics and 11.6% received IMS. Approximately 47% of all prevalent CD patients had mild disease, defined as no advanced therapy and signs of disease activity. Of 6836 (73.6%) patients who did not receive advanced therapy in the follow-up period, 36.3% showed signs of active disease; 40.1% used corticosteroids (including oral budesonide), with 9.9% exhibiting steroid dependency (≥ 1 prescription every 3 months for at least 12 months) in the available follow-up. CONCLUSIONS This study suggests that there remains a large burden of disease among patients who do not receive IMS or biologics in the real world in Germany. A revision of treatment algorithms of patients in this setting according to the latest guidelines may improve patient outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Bernd Bokemeyer
- Interdisciplinary Crohn Colitis Centre Minden, Minden, Germany
| | - Thomas Wilke
- Institut Für Pharmakoökonomie Und Arzneimittellogistik (IPAM) E.V, Wismar, Germany
| | - Marco Ghiani
- Institut Für Pharmakoökonomie Und Arzneimittellogistik (IPAM) E.V, Wismar, Germany
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Zhuleku E, Antolin-Fontes B, Borsi A, Nissinen R, Bravatà I, Barthelmes JN, Le Bars M, Lee J, Passey A, Maywald U, Deiters B, Bokemeyer B, Wilke T, Ghiani M. Real-world outcomes associated with switching to anti-TNFs versus other biologics in Crohn's Disease patients: A retrospective analysis using German claims data. Therap Adv Gastroenterol 2022; 15:17562848221130554. [PMID: 36353736 PMCID: PMC9638528 DOI: 10.1177/17562848221130554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The positioning of new biologic agents for the treatment of Crohn's disease (CD) following failure of initial anti-tumor necrosis factor (anti-TNF) therapy remains a challenge in the real world. OBJECTIVES This study aims to investigate the real-world outcomes associated with the sequential use of biologics in CD patients that newly initiate anti-TNFs, specifically comparing those that switch to another anti-TNF versus biologics with other modes of action. DESIGN Retrospective cohort study. METHODS We identified CD patients who newly began anti-TNF therapy between 1 October 2014 and 31 December 2018 using two German claims databases. Patients were classified as within-class switchers (WCS) if they switched to another anti-TNF or outside-class switchers (OCS) if they switched to vedolizumab (VDZ) or ustekinumab (UST). To compare WCS and OCS, baseline covariates were adjusted through inverse probability of treatment weighting (IPTW), and time-to-event analyses were performed using Cox Proportional Hazard regressions. Results from both databases were meta-analyzed using an inverse variance model. RESULTS Overall, 376 prevalent adult CD patients who initiated anti-TNFs and switched to another biologic were identified. After IPTW, there were 152 and 177 patients in the WCS and OCS group, respectively. WCS were more likely to receive prolonged corticosteroid therapy [hazard ratio (HR): 1.63, 95% confidence interval (CI): 1.17-2.27, p = 0.004], switch a second time to a different biologic (HR: 2.44, 95% CI: 1.63-3.66, p < 0.001), and discontinue treatment (HR: 1.71, 95% CI: 1.25-2.34, p = 0.001) than OCS. CONCLUSION This study suggests that CD patients exhibit more favorable outcomes when switching outside the anti-TNF class to VDZ or UST after initial anti-TNF failure than switching to a second anti-TNF. With loss of response to anti-TNFs as a concern in the real world, comparative evidence from claims data assessing sequential use of biologics can help optimize treatment algorithms of patients after anti-TNF failure.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Bernd Bokemeyer
- Interdisciplinary Crohn Colitis Centre Minden,
Minden, Germany
| | - Thomas Wilke
- IPAM - Institut für Pharmakoökonomie und
Arzneimittellogistik e.V., Wismar, Germany
| | - Marco Ghiani
- IPAM - Institut für Pharmakoökonomie und
Arzneimittellogistik e.V., Wismar, Germany
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Banon T, Weil C, Borsi A, Chodick G, Shakked Z, Barit Ben‐David N. Treatment patterns, persistence with therapy, and outcomes of ustekinumab in Crohn's disease: Real‐world data analysis. JGH Open 2022; 6:120-125. [PMID: 35155821 PMCID: PMC8829097 DOI: 10.1002/jgh3.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/02/2021] [Accepted: 10/10/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Tamar Banon
- Maccabitech Maccabi Institute for Research & Innovation Tel Aviv Israel
| | - Clara Weil
- Maccabitech Maccabi Institute for Research & Innovation Tel Aviv Israel
| | | | - Gabriel Chodick
- Maccabitech Maccabi Institute for Research & Innovation Tel Aviv Israel
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Alulis S, Vadstrup K, Olsen J, Jørgensen TR, Qvist N, Munkholm P, Borsi A. The cost burden of Crohn's disease and ulcerative colitis depending on biologic treatment status - a Danish register-based study. BMC Health Serv Res 2021; 21:836. [PMID: 34407821 PMCID: PMC8371832 DOI: 10.1186/s12913-021-06816-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patients diagnosed with inflammatory bowel disease may be treated with biologics, depending on several medical and non-medical factors. This study investigated healthcare costs and production values of patients treated with biologics. Methods This national register study included patients diagnosed with Crohn’s disease (CD) and ulcerative colitis (UC) between 2003 and 2015, identified in the Danish National Patient Register (DNPR). Average annual healthcare costs and production values were compared for patients receiving biologic treatment or not, and for patients initiating biologic treatment within a year after diagnosis or at a later stage. Cost estimates and production values were based on charges, fees and average gross wages. Results Twenty-six point one percent CD patients and ten point seven percent of UC patients were treated with biologics at some point in the study period. Of these, 46.4 and 45.5 % of patients initiated biologic treatment within the first year after diagnosis. CD and UC patients treated with biologics had higher average annual healthcare costs after diagnosis compared to patients not treated with biologics. CD patients receiving biologics early had lower production values both ten years before and eight years after treatment initiation, compared to patients receiving treatment later. UC patients receiving biologics early had lower average annual production values the first year after treatment initiation compared to UC patients receiving treatment later. Conclusions CD and UC patients receiving biologic treatment had higher average annual healthcare costs and lower average annual production values, compared to patients not receiving biologic treatment. The main healthcare costs drivers were outpatient visit costs and admission costs.
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Affiliation(s)
- Sarah Alulis
- Janssen-Cilag, Bregnerødvej 133, 3460, Birkerød, Denmark.
| | | | | | | | - Niels Qvist
- Surgical Department A and IBD Care, Odense University Hospital, Odense, Denmark
| | - Pia Munkholm
- Gastroenterology Department, North Zealand University Hospital, Frederikssund, Denmark
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Sipponen T, Af Björkesten CG, Hallinen T, Ilus T, Soini E, Eberl A, Heikura M, Kellokumpu M, Koskela R, Nielsen C, Nuutinen H, Heikkinen M, Suhonen UM, Tillonen J, Wennerström ECM, Borsi A, Koivunen MR. A nationwide real-world study on dynamic ustekinumab dosing and concomitant medication use among Crohn's disease patients in Finland. Scand J Gastroenterol 2021; 56:661-670. [PMID: 33820465 DOI: 10.1080/00365521.2021.1906315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Real-world evidence to support optimal ustekinumab dosing for refractory Crohn's disease (CD) patients remains limited. Data from a retrospective nationwide chart review study was utilized to explore ustekinumab dosing dynamics and optimization, identify possible clinical predictors of dose intensification, and to evaluate ustekinumab trough concentrations (TCs) and concomitant medication use in Finland. METHODS Information gathered from17 Finnish hospitals included clinical chart data from 155 adult CD patients who received intravenous ustekinumab induction during 2017-2018. Data on ustekinumab dosing and TCs, concomitant corticosteroid and immunosuppressant use, and antiustekinumab antibodies were analyzed in a two-year follow-up, subject to availability. RESULTS Among 140 patients onustekinumab maintenance therapy, dose optimization was required in 55(39%) of the patients, and 41/47 dose-intensified patients (87%) persisted on ustekinumab. At baseline, dose-intensified patient group had significantly higher C-reactive protein (CRP) levels, and at week 16, significantly lower ustekinumab TCs than in patients without dose intensification. Irrespective of dose optimization, a statistically significant reduction in the use of corticosteroids was observed at both 16 weeks and one year, coupled with an increased proportion of patients on ustekinumab monotherapy. Antiustekinumab antibodies were undetectable in all 28 samples from 25 patients collected throughout the study period. CONCLUSIONS Nearly a third of all CD patients on ustekinumab maintenance therapy, with a history of treatment-refractory and long-standing disease, required dose intensification. These patients persisted on ustekinumab and had significant reduction of corticosteroid use. Increased baseline CRP was identified as the sole indicator of dose intensification. TRIAL REGISTRATION EUPAS30920.
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Affiliation(s)
- Taina Sipponen
- Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Tuire Ilus
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | | | - Anja Eberl
- Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Heikura
- Department of Gastroenterology, North Karelia Central Hospital, Joensuu, Finland
| | - Mikko Kellokumpu
- Department of Internal Medicine, Lapland Central Hospital, Rovaniemi, Finland
| | - Ritva Koskela
- Department of Medicine, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland
| | - Christian Nielsen
- Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland
| | - Heikki Nuutinen
- Division of Gastroenterology, Department of Medicine, Turku University Hospital, Turku, Finland
| | - Markku Heikkinen
- Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Ulla-Maija Suhonen
- Department of Internal Medicine, Kainuu Central Hospital, Kajaani, Finland
| | - Jyrki Tillonen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - E Christina M Wennerström
- Medical Affairs, Janssen Cilag AB, Solna, Sweden.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Andras Borsi
- Janssen Cilag Limited, EMEA HEMAR, High Wycombe, United Kingdom
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Qvist N, Vadstrup K, Alulis S, Borsi A, Munkholm P, Olsen J. Increased use of biologics in the era of TNF-α inhibitors did not reduce surgical rate but prolonged the time from diagnosis to first time intestinal resection among patients with Crohn's disease and ulcerative colitis - a Danish register-based study from 2003-2016. Scand J Gastroenterol 2021; 56:537-544. [PMID: 33736551 DOI: 10.1080/00365521.2021.1897670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND During the last decade, a significant increase in the use of biologic medicine has occurred, accounting for the greatest healthcare expenditure, among inflammatory bowel disease (IBD) patients. The objective of this study was to analyse the prevalence of and time to first intestinal resection surgery in a Danish nationwide cohort of Crohn's disease (CD) and ulcerative colitis (UC) patients, stratified on biologic treatment status. METHODS This retrospective population-based study included IBD patients diagnosed between 2003 and 2015 identified in the Danish National Patient Registry (NPR). The frequency of first-time surgery with intestinal resection and time to surgery was analysed among CD and UC patients between 2003 and 2016. RESULTS A total of 2328 CD and 2128 UC patients underwent surgery between 2003 and 2016 (23% and 10% of all incident CD and UC patients, respectively). Up until 2008, the frequency of surgery gradually declined for both patient groups and an increase in the frequency of patients receiving biological treatment was observed. Subsequently, the frequency of surgery for both CD and UC patients remained stable despite a steady increase in biologic treatment use. CONCLUSIONS The registered increase in the fraction of patients on biologic treatment (mostly TNF-α inhibitors) did not result in changes in the rates of major surgeries with intestinal resection in CD and UC patients.
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Affiliation(s)
- Niels Qvist
- Research Unit for Surgery and IBD-Care, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | | | | | | | - Pia Munkholm
- Gastroenterology Department, North Zealand University Hospital, Frederikssund, Denmark
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8
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Vadstrup K, Alulis S, Borsi A, Gustafsson N, Nielsen A, Wennerström ECM, Jørgensen TR, Qvist N, Munkholm P. Cost Burden of Crohn's Disease and Ulcerative Colitis in the 10-Year Period Before Diagnosis-A Danish Register-Based Study From 2003-2015. Inflamm Bowel Dis 2020; 26:1377-1382. [PMID: 31693731 PMCID: PMC7441097 DOI: 10.1093/ibd/izz265] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The diagnostic delay in inflammatory bowel disease (IBD) is well known, yet the costs associated with diagnoses before IBD diagnosis have not yet been reported. This study explored societal costs and disease diagnoses 10 years before Crohn's disease (CD) and ulcerative colitis (UC) diagnosis in Denmark. METHODS This national register study included patients diagnosed between 2003 and 2015 identified in the Danish National Patient Registry (NPR) and controls who were individually matched on age and sex from the general population. Societal costs included health care services, prescription medicine, home care services, and labor productivity loss. Prediagnostic hospital contact occurring before CD or UC diagnosis was identified using the NPR. Average annual costs per individual were calculated before the patient's first CD or UC diagnosis. A 1-sample t test was then applied to determine significance in differences between cases and controls. RESULTS Among CD (n = 9019) and UC patients (n = 20,913) the average societal costs were higher throughout the entire 10-year period before the diagnosis date compared with the general population. The difference increased over time and equaled €404 for CD patients and €516 for UC patients 10 years before diagnosis and €3377 and €2960, respectively, in the year before diagnosis. Crohn's disease and UC patients had significantly more diagnoses before their CD and UC diagnosis compared with the general population. CONCLUSIONS Compared with the general population, the societal costs and number of additional diagnoses among CD and UC patients were substantially higher in the 10-year period before diagnosis.
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Affiliation(s)
- Kasper Vadstrup
- Janssen-Cilag, Birkerød, Denmark,Address correspondence to: Kasper Vadstrup, PhD, Janssen-Cilag, Bregnerødvej 133, Birkerød, Denmark 3460 ()
| | | | | | | | | | - E Christina M Wennerström
- Janssen-Cilag, Solna, Sweden,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Niels Qvist
- Surgical Department A and IBD Care, Odense University Hospital, Odense, Denmark
| | - Pia Munkholm
- Gastroenterology Department, North Zealand University Hospital, Frederikssund, Capital Region, Denmark
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Vadstrup K, Alulis S, Borsi A, Jørgensen TR, Nielsen A, Munkholm P, Qvist N. Extraintestinal Manifestations and Other Comorbidities in Ulcerative Colitis and Crohn Disease: A Danish Nationwide Registry Study 2003-2016. Crohns Colitis 360 2020; 2:otaa070. [PMID: 36776496 PMCID: PMC9802257 DOI: 10.1093/crocol/otaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 01/13/2023] Open
Abstract
Background Extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) may be a frequent complication to an underlying abnormal immune response. This study investigated the occurrence of EIMs in Crohn disease (CD) and ulcerative colitis (UC) patients using population-based data in Denmark from 2003 to 2016. Methods In this national registry-based study, incident CD and UC patients between 2003 and 2015 were matched on age and gender with non-IBD controls and followed until 2016. The selected EIMs for this study included 51 different diagnoses divided into biological systems of diseases, which were tested for differences in the timing and occurrence of EIMs. Results The study cohort included 10,302 patients with CD and 22,144 patients with UC. The highest risk of patients experiencing EIM/comorbidities for the first time before their IBD diagnosis was in the skin and intestinal tract systems. For CD, the odds ratio of having an EIM before or after IBD diagnosis, as compared with controls, was significant in the skin, intestinal tract, hepatopancreatobiliary, musculoskeletal, ocular, renal, and respiratory systems. For UC, the risks were similar before and after UC diagnosis, apart from the nervous system where the odds ratio was significantly higher before the diagnosis of UC, and significantly lower after diagnosis for diseases in the ocular system. Conclusions EIMs in CD and UC patients may also precede their IBD diagnosis. These findings may indicate a significant diagnostic delay of CD and UC, and the occurrence of known EIMs should prompt physicians to look for patients possibly having underlying IBD.
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Affiliation(s)
- Kasper Vadstrup
- Janssen Immunology, Janssen-Cilag, Birkerød, Denmark,Address correspondence to: Kasper Vadstrup, PhD, Janssen Immunology, Bregnerødvej 133, 3460 Birkerød, Denmark ()
| | - Sarah Alulis
- Janssen Immunology, Janssen-Cilag, Birkerød, Denmark
| | - Andras Borsi
- Janssen Immunology, Janssen-Cilag, High Wycombe, UK
| | | | - Agnete Nielsen
- Department of Market Access and Health Economy, Incentive, Holte, Denmark
| | - Pia Munkholm
- Gastroenterology Department, North Zealand University Hospital, Capital Region, Frederikssund, Denmark
| | - Niels Qvist
- Surgical Department A and IBD Care, Odense University Hospital, Odense, Denmark
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Alulis S, Vadstrup K, Borsi A, Nielsen A, Rikke Jørgensen T, Qvist N, Munkholm P. Treatment patterns for biologics in ulcerative colitis and Crohn's disease: a Danish Nationwide Register Study from 2003 to 2015. Scand J Gastroenterol 2020; 55:265-271. [PMID: 32116064 DOI: 10.1080/00365521.2020.1726445] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: The choice of treatment for Crohn's disease (CD) and ulcerative colitis (UC) depends among other factors, disease severity. Patients with moderate-to-severe disease should be prescribed biologic response modifiers (biologics), according to guidelines. This study aims to explore the treatment patterns of patients diagnosed with CD and UC between 2003 and 2015 that were treated with biologics in Denmark between the years 2003 and 2016.Methods: This national register study included patients diagnosed between 2003 and 2015, identified in the Danish National Patient Registry. Biologic therapies available during the study period were infliximab, adalimumab, vedolizumab and golimumab. The share of patients initiating and receiving biologic treatment in each year was estimated. Additionally, the time from IBD diagnosis to first biologic treatment and time between treatments was calculated.Results: Among 10,302 CD patients and 22,144 UC patients, 28.5% of CD patients and 11.3% of UC patients received treatment with biologics during the study period, with an increasing trend in the number of patients initiating treatment with biologics each year. About 46% of CD patients and 45% of UC patients received their first biologic treatment within the first year after IBD diagnosis. About 57-68% of CD and UC patients received treatment with their second line biologic within 2 months of the last treatment of their first line.Conclusions: The number of patients initiating biologic treatments after diagnosis increased throughout the study period. Most patients diagnosed with CD and UC are receiving biologic treatments relatively soon after their diagnosis.
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Affiliation(s)
| | | | | | | | | | - Niels Qvist
- Research Unit for Surgery, IBD Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Pia Munkholm
- Gastroenterology Department, North Zealand University Hospital, Frederikssund, Denmark
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Fradet C, Kern J, Atanasov P, Wirth D, Borsi A. Impact of surgery and its complications in ulcerative colitis patients in clinical practice: A systematic literature review of real-world evidence in Europe. International Journal of Surgery Open 2020. [DOI: 10.1016/j.ijso.2019.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Vadstrup K, Alulis S, Borsi A, Elkjaer Stallknecht S, Nielsen A, Rikke Jørgensen T, Wennerström C, Qvist N, Munkholm P. Societal costs attributable to Crohn's disease and ulcerative colitis within the first 5 years after diagnosis: a Danish nationwide cost-of-illness study 2002-2016. Scand J Gastroenterol 2020; 55:41-46. [PMID: 31960726 DOI: 10.1080/00365521.2019.1707276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: There is little information on cost-of-illness among patients diagnosed with Crohn's disease (CD) and ulcerative colitis (UC) in Denmark. The objective of this study was to estimate the average 5-year societal costs attributable to CD or UC patients in Denmark with incidence in 2003-2015, including costs related to health care, prescription medicine, home care and production loss.Materials and methods: A national register-based, cost-of-illness study was conducted using an incidence-based approach to estimate societal costs. Incident patients with CD or UC were identified in the National Patient Registry and matched with a non-IBD control from the general population on age and sex. Attributable costs were estimated applying a difference-in-difference approach, where the total costs among individuals in the control group were subtracted from the total costs among patients.Results: CD and UC incidence fluctuated but was approximately 14 and 31 per 100,000 person years, respectively. The average attributable costs were highest the first year after diagnosis, with costs equalling €12,919 per CD patient and €6,501 per UC patient. Hospital admission accounted for 36% in the CD population and 31% in the UC population, the first year after diagnosis. Production loss exceeded all other costs the third-year after diagnosis (CD population: 52%; UC population: 83%).Conclusions: We found that the societal costs attributable to incident CD and UC patients are substantial compared with the general population, primarily consisting of hospital admission costs and production loss. Appropriate treatment at the right time may be beneficial from a societal perspective.
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Affiliation(s)
| | | | | | | | | | | | - Christina Wennerström
- Janssen-Cilag, Solna, Sweden.,Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
| | - Niels Qvist
- Research Unit for Surgery, IBD Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Pia Munkholm
- Gastroenterology Department, North Zealand University Hospital, Frederikssund, Denmark
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Constantin J, Atanasov P, Wirth D, Borsi A. Indirect costs associated with ulcerative colitis: a systematic literature review of real-world data. BMC Gastroenterol 2019; 19:179. [PMID: 31706270 PMCID: PMC6842452 DOI: 10.1186/s12876-019-1095-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 10/17/2019] [Indexed: 01/06/2023] Open
Abstract
Background The economic burden of ulcerative colitis (UC), specifically related to indirect costs, is not extensively documented. Understanding and quantifying it is required by health care decision makers. Aim To assess the impact of indirect costs of UC in observation studies. Method A systematic literature search was conducted in MEDLINE®, Embase® and Cochrane Library to capture all relevant publications reporting outcomes on absenteeism, presenteeism and productivity losses in moderate to severe UC. Eligibility criteria for inclusion into the review were established using a predefined PICOS scheme. All costs were adjusted to 2017 currency values (USD dollars, $). Results In total, 18 studies reporting data on indirect costs were included in the analysis. Absenteeism costs were classified into three categories: sick leave, short-term and long-term disability. Most of the studies captured absenteeism costs related specifically to sick leave, which was experienced on average by 10 to 24% patients with UC. Only three studies captured presenteeism costs, as these are difficult to measure, however costs ranged from 1602 $ to 2947 $ per patient year. The proportion of indirect costs accounted for 35% of total UC costs (Total UC costs were defined as the sum of healthcare costs, productivity costs and out-of-pocket costs). Discussion A limited number of studies were identified describing the indirect costs in patients with moderate to severe UC. Insufficient data on different components of costs allowed a limited analysis on the impact of indirect costs in patients with UC. Further studies are needed to gain an understanding of the influence of UC on patients’ functional abilities.
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Gemayel NC, Rizzello E, Atanasov P, Wirth D, Borsi A. Dose escalation and switching of biologics in ulcerative colitis: a systematic literature review in real-world evidence. Curr Med Res Opin 2019; 35:1911-1923. [PMID: 31192706 DOI: 10.1080/03007995.2019.1631058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Biologics used to treat ulcerative colitis (UC) may lose their effect over time, requiring patients to undergo dose escalation or treatment switching, and systematic literature reviews of real-world evidence on these topics are lacking. Aim: To summarize the occurrence and outcomes of dose escalation and treatment switching in UC patients in real-world evidence. Methods: Studies were searched through MEDLINE, MEDLINE IN PROCESS, Embase and Cochrane (2006-2017) as well as proceedings from three major scientific meetings. Results: In total, 41 studies were included in the review among which 35 covered dose escalation and 12 covered treatment switching of biologics. Tumor necrosis factor antagonist (anti-TNF) escalation for all patients included at induction ranged from 5% (6 months) to 50% (median 0.67 years) and 15.2% to 70.8% (8 weeks) for anti-TNF induction responders. Mean/median time to dose escalation on anti-TNF ranged from 1.84 to 11 months. The most common switching pattern, infliximab → adalimumab, occurred in 3.8% (median 5.6 years) to 25.5% (mean 3.3 years) of patients. Conclusions: Dose escalation and treatment switching of biologics may be considered as indicators of suboptimal therapy suggesting a lack of long-term remission and response under current therapies.
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Affiliation(s)
- Nathalie C Gemayel
- Health Economics & Market Access (HEMA), Amaris Consulting Ltd , Barcelona , Spain
| | - Eugenio Rizzello
- Health Economics & Market Access (HEMA), Amaris Consulting Ltd , London , UK
| | - Petar Atanasov
- Health Economics & Market Access (HEMA), Amaris Consulting Ltd , Barcelona , Spain
| | - Daniel Wirth
- Market Access, Janssen-Cilag GmbH , Neuss , Germany
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Eberl A, Hallinen T, Af Björkesten CG, Heikkinen M, Hirsi E, Kellokumpu M, Koskinen I, Moilanen V, Nielsen C, Nuutinen H, Suhonen UM, Utriainen K, Vihriälä I, Soini E, Wennerström C, Nissinen R, Borsi A, Koivunen M, Tillonen J, Sipponen T. Ustekinumab for Crohn's disease: a nationwide real-life cohort study from Finland (FINUSTE). Scand J Gastroenterol 2019; 54:718-725. [PMID: 31184512 DOI: 10.1080/00365521.2019.1624817] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Ustekinumab (UST), a human anti-IL12/23p40 monoclonal antibody, has been approved for treatment of Crohn's Disease (CD) since the end of 2016. This nationwide noninterventional, retrospective chart review explored real-life data in patients receiving UST to provide guidance in UST treatment in the era of increasing prevalence of CD. Methods: The study assessed UST treatment patterns such as dosing frequency, concomitant medication and persistence in 48 CD patients commencing UST therapy in 12 Finnish hospitals during 2017. Clinical remission and response rates were explored using a modified Harvey-Bradshaw index (mHBI) and endoscopic response via the simple endoscopic score for Crohn's disease (SES-CD) as proportions of patients at week 16 and at the end of follow-up. Results: Forty patients (83%) continued UST-treatment at the end of follow-up. At week 16, clinical response and endoscopic healing was observed, where data were available; mHBI decreased from 9 to 3 (p = .0001) and SES-CD from 12 to 3 (p = .009). Clinical benefit was achieved by 83% (19/23) at week 16 and by 76% (16/21) at the end of follow-up. The proportion of patients using corticosteroids decreased from 48% to 25% at week 16 and to 13% at the end of the follow-up. Conclusion: UST showed to be effective and persistent, inducing short-term clinical benefit and endoscopic response in this real-life nationwide study of CD patients. Significant corticosteroid tapering in patients with highly treatment refractory and long-standing CD was observed.
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Affiliation(s)
- Anja Eberl
- Gastroenterology, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | | | | | - Markku Heikkinen
- Department of Internal Medicine, Kuopio University Hospital , Kuopio , Finland
| | - Eija Hirsi
- Department of Internal Medicine, South Karelia Central Hospital , Lappeenranta , Finland
| | - Mikko Kellokumpu
- Department of Internal Medicine, Lapland Central Hospital , Rovaniemi , Finland
| | - Inka Koskinen
- Department of Internal Medicine, Central Finland Central Hospital , Jyväskylä , Finland
| | - Veikko Moilanen
- Department of Internal Medicine, Satakunta Central Hospital , Pori , Finland
| | - Christian Nielsen
- Department of Internal Medicine, Vaasa Central Hospital , Vaasa , Finland
| | - Heikki Nuutinen
- Division of Gastroenterology, Department of Medicine, Turku University Hospital , Turku , Finland
| | - Ulla-Maija Suhonen
- Department of Internal Medicine, Kainuu Central Hospital , Kajaani , Finland
| | - Karri Utriainen
- Division of Gastroenterology, Department of Medicine, Turku University Hospital/Salo Hospital , Salo , Finland
| | - Ilkka Vihriälä
- Department of Internal Medicine, Central Ostrobothnia Central Hospital Kokkola , Finland
| | | | - Christina Wennerström
- Medical Affairs, Janssen Cilag AB Solna , Sweden.,Department of Epidemiology Research, Statens Serum Institut , Denmark Copenhagen
| | | | - Andras Borsi
- Janssen Cilag Limited, EMEA HEMAR , High Wycombe , United Kingdom
| | | | - Jyrki Tillonen
- Department of Internal Medicine, Päijät Häme Central Hospital , Lahti Finland
| | - Taina Sipponen
- Gastroenterology, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Bitter I, Czobor P, Borsi A, Fehér L, Nagy BZ, Bacskai M, Rakonczai P, Hegyi R, Németh T, Varga P, Gimesi-Országh J, Fadgyas-Freyler P, Sermon J, Takács P. Mortality and the relationship of somatic comorbidities to mortality in schizophrenia. A nationwide matched-cohort study. Eur Psychiatry 2017; 45:97-103. [PMID: 28753464 DOI: 10.1016/j.eurpsy.2017.05.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022] Open
Abstract
AIM We conducted a matched-cohort study to assess mortality in schizophrenia and the relationship of mortality with comorbid somatic conditions and suicide attempts. METHOD A full-population register-based prospective matched-cohort study was performed including all eligible patients with schizophrenia in Hungary between 01/01/2005 and 31/12/2013. Control subjects were individually matched to patients with schizophrenia at a 5:1 ratio. The principal outcome measure was death due to any reason. A non-parametric approach was used for descriptive statistical purposes, the Kaplan-Meier model for survival analysis, and the Cox proportional-hazards regression model for inferential statistics. RESULTS Patients with schizophrenia (n=65,169) had substantially higher risk of all-cause mortality than the control subjects (n=325,435) (RR=2.4; P<0.0001). Comorbidities and suicide attempts were associated with significantly increased mortality in both groups. As compared to the controls, 20-year old males with schizophrenia had a shorter life expectancy by 11.5years, and females by 13.7years; the analogous numbers for 45-year old schizophrenics were 8.1 and 9.6years, respectively. CONCLUSIONS A significant mortality gap - mainly associated with somatic comorbidities - was detected between patients with schizophrenia and individually matched controls. Improved medical training to address the disparity in mortality, and many other factors including lack of resources, access to and model of medical care, lifestyle, medication side effects, smoking, stigma, need for early intervention and adequate health care organization could help to better address the physical health needs of patients with schizophrenia.
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Affiliation(s)
- I Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
| | - P Czobor
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - A Borsi
- Janssen-Cilag Hungary Ltd., Balassa u. 6, 1083 Budapest, Hungary
| | - L Fehér
- Janssen-Cilag Hungary Ltd., Balassa u. 6, 1083 Budapest, Hungary
| | - B Z Nagy
- Janssen-Cilag Hungary Ltd., Balassa u. 6, 1083 Budapest, Hungary
| | - M Bacskai
- Healthware Ltd., Nagyenyed u. 8-14., 1123 Budapest, Hungary
| | - P Rakonczai
- Healthware Ltd., Nagyenyed u. 8-14., 1123 Budapest, Hungary
| | - R Hegyi
- Healthware Ltd., Nagyenyed u. 8-14., 1123 Budapest, Hungary
| | - T Németh
- Healthware Ltd., Nagyenyed u. 8-14., 1123 Budapest, Hungary
| | - P Varga
- National Health Insurance Fund Administration (NHIF), Közraktár u. 32., 1093 Budapest, Hungary
| | - J Gimesi-Országh
- National Health Insurance Fund Administration (NHIF), Közraktár u. 32., 1093 Budapest, Hungary
| | - P Fadgyas-Freyler
- National Health Insurance Fund Administration (NHIF), Közraktár u. 32., 1093 Budapest, Hungary
| | - J Sermon
- Janssen-Cilag EMEA Ltd., Váci út 73/A, 1139 Beerse, Belgium
| | - P Takács
- Janssen-Cilag Hungary Ltd., Balassa u. 6, 1083 Budapest, Hungary
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