OBJECTIVES : Drug treatment strategies for Crohn’s disease (CD) and ulcerative colitis (UC) include step-up (SU) and top-down (TD) therapy. SU therapy initiates with oral anti-inflammatory agents, while TD therapy initiates with biologics or immunomodulators. This research examined the utilization of TD and SU therapy in CD and UC using claims data.

METHODS : We conducted a retrospective cohort study using Optum’s de-identified Clinformatics® Data Mart Database for years 2010 through 2018. Patients with at least two separate diagnosis codes for CD or UC were included. TD or SU treatment strategies were assigned based on the first drug prescribed for CD or UC filled after a six-month period without a CD- or UC-indicated drug claim and within 60-days of the first diagnosis. Additionally, we compared the proportion of TD or SU therapy use during 2010-2012 and 2016-2018. Statistical significance of differences in TD or SU therapy according to age, gender and time periods were assessed with chi-squared tests and t-tests.

RESULTS : We identified 8,940 CD and 16,186 UC patients initiated on drug therapy. The CD cohort had 3,274 (36.62%) patients using TD therapy and 5,666 (63.38%) patients using SU therapy. The UC cohort had 1,591 (9.83%) patients using TD therapy and 14,595 (90.17%) patients using SU therapy. Age and gender were significantly different (p<0.001) between treatment strategies for both CD and UC, with the TD cohort having a higher percentage of males (54.12%; 54.93%, respectively) and a lower mean age (TD: 34.8[SD:18.1], 39.8[18.5]; SU: 44.1[19.6], 46.6[18.8], respectively). The rate of TD therapy utilization was higher in 2016-2018 than 2010-2012 for both CD (42.7%; 29.6%, respectively) and UC (11.4%; 8.17%, respectively; p < 0.0001 for both comparisons).

CONCLUSIONS : We found the frequency of TD therapy utilization has increased between 2010-2012 and 2016-2018. These findings can inform policies for resource optimization.