P1618 - Non-Adherence to Self-injectable Biologic Therapy in IBD Increases ED Visits and Hospitalizations

Erin Causey, BS¹, Nisha Shah, PharmD², Chris Slaughter, PhD², Jonah Jarabek, BS³, Autumn Zuckerman, PharmD, BCPS, AAHIVP, CSP², Susan Chhen, PharmD⁴, Elizabeth Scoville, MD, MSCI², Robin Dalal, MD², Dawn Beaulieu, MD², Baldeep Pabla, MD, MSCI², David Schwartz, MD², Raymond K. Cross, MD, MS⁵, Byron Vaughn, MD³, Lauren George, MD⁶, Sara Horst, MD, MPH, FACG^2
1University of Maryland, Baltimore, MD; ²Vanderbilt University Medical Center, Nashville, TN; ³University of Minnesota Medical Center, Minneapolis, MN; ⁴Fairview Pharmacy Services, Minneapolis, MN; ⁵University of Maryland School of Medicine, Baltimore, MD; ⁶University of Maryland School of Public Health, Baltimore, MD

Introduction: Non-adherence to self-injectable biologic therapy in patients with inflammatory bowel disease (IBD) is common (one national study reported 56% adherence) and negatively impacts clinical outcomes.¹ This analysis evaluated adherence rates and health outcomes across three academic centers with integrated specialty pharmacies.
1. Govani S, Noureldin M, Higgins P, et al. Am J Gastroenterol. 2018;113:276

Methods: We performed a retrospective cohort analysis of adult patients with IBD receiving care at three tertiary care outpatient clinics (Vanderbilt University Medical Center, University of Maryland, University of Minnesota). Patients prescribed a self-injectable anti-TNF (adalimumab, certolizumab, golimumab) or anti-IL 12/23 therapy (ustekinumab) and received medication (> 3 pharmacy fills) through the center’s integrated specialty pharmacy were included. Data was extracted from electronic medical record and pharmacy claims database.

Medication adherence was calculated using medication possession ratio (MPR), with non-adherence defined as an MPR < 0.86. Health outcomes included IBD-related emergency department (ED) visits and/or hospitalizations. Statistical analysis was performed using Wilcox rank sum test, Pearson’s Chi-squared test, and logistic regression models.

Results: Six hundred and eight subjects were included (Table 1). The median follow-up time was 903 days (range 187, 3900). Median MPR was similar across centers (Center 1: 0.94 [IQR 0.62, 1], Center 2: 0.99 [IQR 0.69, 1], and Center 3: 0.92 [IQR 0.77, 1]), p = NS. The percent of patients achieving adherence of MPR > 0.86 was similar across centers (Center 1: 70%, Center 2: 68%, Center 3: 69%), p = NS. Twenty-two percent (133/608) of patients had >1 IBD-related ED visit. In the unadjusted analysis, non-adherence increased the likelihood of ED visits (RR 1.53, 95% CI 1.1, 2.09). The finding remained significant after adjusting for age, sex, race, and disease type (RR 1.45, 95% CI 1.05, 1.97). Twenty three percent (141/608) of patients had >1 IBD-related hospitalizations. In the unadjusted analysis, non-adherence increased the likelihood of hospitalization (RR 1.59, 95% CI 1.19, 2.13). This finding remained significant after adjusting for age, sex, race, and disease type (RR 1.60, 95% CI 1.16, 2.10). Findings summarized in Figure 1.

Discussion: This multicenter analysis found that centers with specialty pharmacies had high adherence rates. Non-adherence was associated with higher likelihood of ED visits and hospitalizations.




Disclosures:


Erin Causey, BS¹, Nisha Shah, PharmD², Chris Slaughter, PhD², Jonah Jarabek, BS³, Autumn Zuckerman, PharmD, BCPS, AAHIVP, CSP², Susan Chhen, PharmD⁴, Elizabeth Scoville, MD, MSCI², Robin Dalal, MD², Dawn Beaulieu, MD², Baldeep Pabla, MD, MSCI², David Schwartz, MD², Raymond K. Cross, MD, MS⁵, Byron Vaughn, MD³, Lauren George, MD⁶, Sara Horst, MD, MPH, FACG². P1618 - Non-Adherence to Self-injectable Biologic Therapy in IBD Increases ED Visits and Hospitalizations, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.