Introduction
Inflammatory bowel disease (IBD) prevalence is steadily increasing worldwide, particularly in developed countries. In parallel, the medical treatment of IBD evolved significantly with the marketing approval of advanced therapies over the last decade. The aim of this study was to describe the epidemiology of IBD and to assess treatment patterns in real-life management in France.
Aims & Methods
This was an observational study using the French National Health Databases (SNDS) including all adult patients diagnosed with Crohn disease (CD) or ulcerative colitis (UC) meeting at least one of the following criteria between 2014 and 2021: i) long term disease (LTD) related to IBD ii) at least 2 hospital stays for IBD iii) one hospital stay for IBD and 3 or more IBD treatment deliveries. A look-back period of at least 5 years prior to index date was considered to assess epidemiology and patients’ characteristics, and a follow-up period of at least 12 months to describe treatment patterns.
Results
In the study period, 274,694 IBD patients were identified: 139,001 CD patients (including 45,939 (33.0%) incident patients), and 135,693 UC patients (including 53,939 (39.8%) incident patients). CD prevalence varied from 193.5 per 100,000 person-years (py) in 2014 to 234.4 per 100,000 py in 2021, while incidence varied from 12.1 to 9.7 per 100,000 py respectively. UC prevalence and incidence varied respectively from 173.1 to 229.2 per 100,000 py and from 13.7 to 11.8 per 100,000 py.
Prevalent CD patients were 56.7% female, median age was 42 years (IQR 31-56) and median follow-up was 8.0 years (IQR 4.6-8.0). Among patients with at least 1 year of follow up, 42.3% were exposed to at least one biologic: 96.9% received an anti-TNF in first line, 1.6% an anti-interleukin, 1.4% an anti-integrin and 36.4% received a concomitant immunosuppressant. Among incident CD patients (54.6% female, median age of 37 years (IQR 26-53) and median follow-up of 3.9 years (IQR 2.0-5.9)), 50.8% of patients with at least 1 year of follow-up were exposed to at least one biologic. The treatment distribution in first line was similar to prevalent patients.
Prevalent UC patients were 50.8% male, median age was 49 years (IQR 36-62) and median follow-up was 8.0 years (IQR 3.9-8.0). Among patients with at least 1 year of follow up, 20.3% were exposed to at least one biologic: 94.0% received an anti-TNF in first line, 5.3% received an anti-integrin, 0.4% an anti-interleukin, 0.3% a JAK inhibitor (JAKi) and 34.5% received a concomitant immunosuppressant. Among incident UC patients (50.9% male, median age of 43 years (IQR 31-58) and median follow-up of 3.8 years (IQR 1.9-5.8)), 23.5% of patients with at least 1 year of follow-up were exposed to at least one biologic, with comparable treatment distribution in first line as in prevalent patients.
After a switch or a swap from an anti-TNF in first line for CD, the use of anti-TNF in second line tends to decrease (from 92.8% in 2014 to 36.2% in 2020) in favor of anti-integrins (from 2.3% to 16.7%) and anti-interleukins (from 4.9% to 47.1%). The same trend is observed for UC, for anti-TNF (from 93.8% to 30.0%), mostly in favor of anti-integrins (from less than 5.6% to 57.0%).
Conclusion
This study reports an increase in prevalence and a slight decrease in incidence of IBD in France between 2014 and 2021. Treatment patterns evolved with an increased use of advanced therapies and a swap out of class in the second line.
Disclosure
LV received fees from abbvie, amgen, MSD, Ferring, Takeda, Pfizer, Janssen, Lilly, Galapagos, Celltrion, Viatris
LPB received fees from Abbvie, Abivax, Alimentiv, Alma Bio Therapeutics, Amgen, Applied Molecular Transport, Arena, Biogen, BMS, Celltrion, Connect Biopharm, Cytoki Pharma, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, Gossamer Bio, GSK, Hac Pharma, IAC Image Analysis, Index Pharmaceuticals, Inotrem, Janssen, Lilly, Medac, Mopac, Morphic, MSD
Norgine, Novartis, OM Pharma, ONO Pharma, OSE Immunotherapeuthics, Pandion Therapeuthics, Par' Immune, Pfizer, Prometheus, Protagonist, Roche, Roivant, Samsung, Sandoz, Sanofi, Takeda, Theravance, Thermo Fischer, Tigenix, Tillots, Viatris, Vifor, Vectivbio, Ventyx, Ysopia
JK received fees from Janssen, Takeda, Lilly, Abbvie, Pfizer, Tillots, Amgen, Celltrion, Roche, Gilead, Galapagos
SC, HO, LG, KS, LC works for Janssen-Cilag
PR, GB, TN works for IQVIA
