Utilization Trends of Anti-TNF Agents and Health Outcomes in Adults and Children with Inflammatory Bowel Diseases: A Single-center Experience

Since 1998, biologic agents (monoclonal antibodies that bind tumor necrosis factor alpha [TNF-α]) represent the newest and potentially the most effective medical therapy among all the immune-suppressive medications for Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC). Infliximab has been shown in large clinical trials to be efficacious in induction and maintenance of remission for both CD1,2 and UC.3 Adalimumab, launched in the early 2007, has established effectiveness in CD4-6 and more recently in UC.7,8 Certolizumab has also been shown to be superior to placebo in clinical trials.9,10 Preliminary data suggest that the increasing use of biologics or anti-TNF agents in inflammatory bowel disease (IBD) correlates with improved health outcomes in hospitalization and surgical rates.11,12 However, there is some evidence and renewed discussion that increased use of anti-TNF agents does not always yield reduced morbidity from IBD-related hospitalizations and abdominal surgeries, especially considering the waning long-term durability of biologics’ efficacy.13-19 Precise utilization trends and long-term health outcomes remain incompletely characterized, especially in pediatric IBD. Furthermore, because there are no head-to-head comparative effectiveness trials between infliximab and adalimumab, it is difficult to assess potential differences between the efficacy profiles of the 2 drugs in maintaining IBD clinical remission. Based on our center’s clinical experience in treating IBD, we hypothesize that overall use of anti-TNF agents is increasing and may correlate with impact on hospitalization and IBD-related abdominal surgery rates for IBD exacerbations. The aims of this study were to: (1) describe recent utilization trends of infliximab and adalimumab, (2) determine the correlation of infliximab and adalimumab use with hospitalization and surgery rates, and (3) describe any differences in drug use between adults and children with IBD.