A retrospective analysis of treatment patterns, drug discontinuation and healthcare costs in Crohn’s disease patients treated with biologics

Background/aims: This real-world analysis evaluated the persistence and direct healthcare costs of Crohn’s Disease (CD) patients treated with biologics in Italy. Methods: A retrospective analysis on administrative databases of Italian healthcare entities, covering 10.4 million residents, was performed. Adult CD patients under biologics between 2015 and 2020 were in- cluded and attributed to first/second treatment line based on absence/presence of biologic prescriptions 5-years before index-date (first biologic prescription). Results: Of 16,374 CD patients identified, 1,398 (8.5%) were biologic-treated: 1,256 (89.8%) in first line and 135 (9.7%) in second line. Kaplan-Meier curves estimated a higher persistence for ustekinumab- treated patients followed by vedolizumab, infliximab and adalimumab, in both lines. Considering base- line variables and adalimumab as reference, infliximab in first line (HR: 0.537) and ustekinumab in first (HR: 0.057) and second line (HR: 0.213) were associated with significantly reduced risk of drug- discontinuation. First line total/average healthcare direct-costs were €13,637, €11,201, €17,104 and €18,340 in patients persistent on adalimumab, infliximab, ustekinumab and vedolizumab, respectively. Conclusions: This real-world analysis showed differences in persistence over 12-months between biologic treatments, being higher in ustekinumab-treated group, followed by vedolizumab, infliximab and adali- mumab. Patients’ management was associated with comparable direct healthcare costs among treatment lines, mainly driven by drug-related expenses.