S1761 Treatment Patterns, Clinical Characteristics, and Economic Burden of Combined Advanced Therapy in Patients With Inflammatory Bowel Disease: A Retrospective US Database Review

Introduction: Several advanced therapies exist for patients with ulcerative colitis (UC) and Crohn’s disease (CD); however, up to 60% of patients relapse. Combining advanced therapies that target different pathways may achieve greater efficacy. This study evaluated prevalence, duration, clinical characteristics, healthcare resource utilization (HRU) and costs of combined advanced therapies vs monotherapy. Methods: This retrospective cohort study used the MarketScan Commercial Claims Encounters database (1 Jan 2013 to 31 Dec 2022). Included patients were adults with UC or CD and prior use of ≥1 advanced therapy and ≥6 months of data before and after the index date. The index date for combined therapy reflects the start of overlap. Monotherapy patients were assigned a mock-index date that followed a randomly matched duration of monotherapy from patients in the combined therapy group. The frequency of patients with combined therapy across multiple overlap periods was used to establish a clinically relevant definition of combined advanced therapies. Results: Combination therapies were defined as overlapping use of >1 advanced therapy for at least 30 days. Combined therapy prevalence was low (CD: 2.9%; UC: 3.9%). The most frequent duration for overlapping combined therapy was 30–59 days (CD: 33.6%; UC: 35.9%), with vedolizumab + infliximab being the most prevalent combination (CD: 27.7%; UC: 26.7%). Most patients discontinued combined therapy with significant drops by 6 months. Among combinations, vedolizumab + ustekinumab demonstrated the longest persistence (median duration; CD: 3.3 mo; UC: 3.7 mo). At baseline, the combination cohort exhibited younger age, higher comorbidity burden, greater diagnostic testing, and significantly higher HRU and costs vs the monotherapy cohort. Combined therapy during the 6-month study period led to higher all-cause costs than monotherapy (CD: $124,928 vs $43,239; UC: $90,763 vs $39,941), suggesting that combination therapy be used to regain control of disease rather than as a long-term option. Conclusion: The prevalence of combined advanced therapies is relatively low, but frequently includes administration of vedolizumab. Patients on combined advanced therapies had higher disease burden, HCRU and healthcare costs vs monotherapy. Higher initial costs of combination therapy may be offset by achieving long-term disease control with subsequent monotherapy.