Early Initiation of Dual Therapy Benefits Veterans with Crohn’s

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HOUSTONPatients with the inflammatory bowel diseases (IBD ) Crohn’s disease or ulcerative colitis are more likely to benefit if dual therapy with infliximab and an immunomodulator is initiated earlier in their first year of therapy, according to a new study from the Michael E. DeBakey VAMC and Baylor College of Medicine, both in Houston.1

The study was designed to determine the effectiveness of early treatment with biologics and immunomodulator therapy on healthcare utilization by assessing rates of hospitalization and surgery within one year after initiation of infliximab and/or immunomodulator therapy in veterans with IBD. Results were published recently in Clinical Gastroenterology and Hepatology.

The researchers used administrative data from 176 Department of Veterans Affairs facilities from Oct. 1, 2001, through Sept. 30, 2009, to conduct a retrospective, observational cohort study of 20,474 veterans with Crohn’s disease or ulcerative colitis. Employing inpatient, outpatient and death records, the investigators linked that data longitudinally with prescription-fill information, assessing for treatment with infliximab, immunomodulators, both (dual therapy) or neither for each person-day of follow-up.

The study group — 93.9% male; 72.5% white; mean age, 60.9 — included 8,042 patients with Crohn’s disease and 12,432 with ulcerative colitis prescribed infliximab (0.17%), immunomodulator (1.3%) or dual therapy (1.5%). The results using adjusted models indicated 50% relative reductions in hospitalization among patients who received 9.2 months of immunomodulator monotherapy, eight months of infliximab, or 7.7 months of dual therapy. At the same time, a 50% relative reduction in surgery was observed among patients receiving seven months of infliximab or five months of dual therapy.

Overall, analysis of dose-response data revealed 73.1% and 92% reductions in risk of hospitalization and surgery, respectively, after nine months of dual therapy.

“On the basis of a retrospective cohort study, dual therapy with infliximab and an immunomodulator for less than eight months is associated with significant reductions in hospitalization and surgery within one year of the start of therapy,” the authors concluded.

1Abraham NS, Richardson P, Castillo D, Kane SV. Dual therapy with infliximab and immunomodulator reduces one-year rates of hospitalization and surgery among veterans with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2013 Oct;11(10):1281-7. doi: 10.1016/j.cgh.2013.06.004. Epub 2013 Jun 19. PubMed PMID: 23792295.

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