(P-052) Evaluation the Pattern of Treatment in Inflammatory Bowel Disease: Before and After Approved Policy on Biologicals

Background: Biologics was reimbursed for inflammatory bowel disease (IBD) in Taiwan since 2011/7/1. However, limited information for prescription pattern and the impact of the policy. The changes of treatment pattern in IBD patients between pre- and post-biologics era is to be explored.

Objectives: To assesses the pattern of IBD treatment and steroid dependent rate in pre- and post-biologics era.

Methods: A retrospective cohort study was conducted using the National Health Insurance Database from 2003-2018. We enrolled new cases with IBD diagnosis and IBD-related-prescription within 3 years after IBD diagnosis. We separate them into pre- and post-biologics era based on 1st IBD-related-prescription date. Following treatment groups have been analyzed: 5-aminosalicylic acid, steroid, immunomodulators (IMM), biologics and others. The definition of steroid-dependence is the patients using steroid more than 3 months and received any dose of steroid over 10 mg of prednisolone equivalent after the 3rd month. We applied the Cochran-Armitage test for trend among 8 half-year periods in pre- and post-biologics era.

Results: Total 15,048 IBD patients eligible for the analysis; 4476 (29.75%) diagnosed with Crohn’s disease (CD), 10572 (70.25%) with ulcerative colitis (UC), 4.88% of CD and 15.55% of UC patients had catastrophic illness certificate. We found a statistically significant decreased treatment trend in 5-ASA and steroid in CD/UC, pre- and post-biologics era from 1st to 8th half-year (P-value <0.0001). The proportion of IMM use in post-biologic era was higher than in pre-biologic era (e.g. 5.6% in pre-era and 13.5% in post-era for CD, 2.2% and 4.4% for UC in 1st half-year), while the use of steroid were decreased in the post-biologic era (e.g. 71.4% in pre-era and 56.9% in post-era for CD, 41.6% and 31.7% for UC in 1st half-year period) in IBD patients. Increased biologic prescription ratio in post-biologics era showed from 9.8% in 1st half-year period to 29.2% in 8th half-year period for CD, 1.1% to 9.9% for UC (P-value <0.0001). Adalimumab is the most prescribed biologicals in IBD. Declined steroid-dependent rate was manifested in post-biologics era, 22.14 and 15.9 per 1,000 person-years in CD and UC, Compared to 25.2 and 21.02 per 1,000 persons-years in pre-biologics era.

Conclusions: Within policy on biologicals in IBD, elevated prescription ratio of biologics and immunomodulators was expected. In future studies, it is important to evaluate the clinical impact of biologicals including decline steroid-dependent rate.