Inflammatory Bowel Diseases

Skip Navigation LinksHome > November 2013 - Volume 19 - Issue 12 > Impact of JC Virus Antibody Testing in Patients with Crohn's...
Inflammatory Bowel Diseases:
doi: 10.1097/01.MIB.0000437043.36338.21
Original Clinical Articles

Impact of JC Virus Antibody Testing in Patients with Crohn's Disease with Loss of Response to Infliximab: A Markov Model

Scott, Frank I. MD, MSCE*,†,‡; Osterman, Mark T. MD, MSCE*,‡; McConnell, Ryan A. MD; Lorusso, Monica MD§; Aberra, Faten MD, MSCE*,‡; Kerner, Caroline MD, MSCE*,‡; Lichtenstein, Gary R. MD*,‡; Lewis, James D. MD, MSCE*,†,‡

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Background: The optimal treatment strategy for patients with Crohn's disease who have loss of response to the anti–tumor necrosis factor α medication infliximab is uncertain. Natalizumab has an alternative mechanism of action, but its use has been limited by the risk of progressive multifocal leukoencephalopathy. In this study, we performed a decision analysis assessing the impact of JC virus (JCV) antibody testing and natalizumab utilization for loss of response to infliximab.

Methods: We constructed a Markov model to assess the difference between unscreened natalizumab use (option 1), JCV antibody testing with natalizumab when appropriate (option 2), and second anti–tumor necrosis factor α use (option 3). The base case was a 35-year-old man with severe Crohn's disease with loss of response to infliximab. The time horizon was 3 years. Results are reported in quality-adjusted life years (QALYs). Deterministic and probabilistic analyses were conducted. Markov analysis using a cohort of 5000 individuals was performed. The impact of JCV antibody status on outcomes in this model was assessed.

Results: Option 2 was the preferred strategy (2.0880 QALYs), followed by option 1 (2.0875 QALYs) and option 3 (2.0808 QALYs). Patients in option 2 required fewer surgeries compared with option 3. Previous JCV infection was associated with reduced QALYs with all options that allowed for natalizumab use.

Conclusions: JCV antibody testing and subsequent treatment selection yield improved outcomes over natalizumab without testing or using only a second anti–tumor necrosis factor α in all patients.

© Crohn's & Colitis Foundation of America, Inc.

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