Crohn's disease: switch to TNFi tops continued steroids for QoL

  • Inflamm Bowel Dis

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • The switch to TNF-inhibitor (TNFi) therapy in patients with Crohn's disease (CD) is associated with greater QoL, as measured by remission-time equivalent (RTE), than continued use of corticosteroids.

Why this matters

  • Switching to TNFi may be the preferred treatment strategy to improve QoL.

Study design

  • Retrospective cohort (n=1563 new TNFi users) using Medicaid data (2001-2005) and Medicare data (2006-2013) and a Monte Carlo simulation designed to add sensitivity. 
  • Beneficiaries with CD using continued corticosteroids were compared with new users of TNFi who had switched from corticosteroids.
  • QoL was measured by estimated RTEs, based on rates of disease- and therapy-related adverse events, including death, serious infection, hospitalization.
  • Funding: Patient Centered Outcomes Research Initiative.

Key results

  • The TNFi group had higher mean RTEs than the continued corticosteroid group, using retrospective cohort data:
    • at 6 months, 1.866 (±2.006) vs 1.357 (±1.876) RTEs (mean incremental difference [MID], 0.5093; 95% CI, 0.3708-0.6477); and
    • at 24 months, 12.513 (±7.308) vs 11.106 (±6.978) RTEs (MID, 1.4075; 95% CI, 0.8506-1.9645).
  • The TNFi group had higher mean RTEs, using Monte Carlo simulation analysis (5.521 [95% CI, 5.316-5.718] vs 3.656 [95% CI, 3.436-3.865]; incremental difference, 1.866) and confirmed by multiple sensitivity and latent class (specific subpopulation) analysis.

Limitations

  • Retrospective observational design.

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