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Biological and Immunomodulator Use in Crohn's Disease in a Medicaid Population

Flasar, Mark H. MD, MS; Chao, Jingdong PhD; Ozbay, A. Burak MBA, PhD; Skup, Martha PhD; Lu, Mei MS; Cross, Raymond MD, MS

doi: 10.1097/MIB.0000000000000730
Original Article

Background: Immunomodulator and biological use in African Americans (AA) with Crohn's disease (CD) has been reported to be lower than in whites (W); less data exist for Hispanics (H).

Methods: Medicaid databases from 3 states were examined for patients with CD from August 1998 to July 2009. CD-related treatments, comorbidities, location, surgery, and health care utilization were assessed from diagnosis until the first biological claim or end of claims. A Cox proportional hazard regression model was used to assess the effect of race on biological initiation.

Results: A total of 5575 patients with CD (3590 W; 924 AA; 494 H; and 567 “other”) were analyzed; 18%, 17%, and 17% of W, AA, and H patients, respectively, started immunomodulators (P = not significant); and 7%, 9%, and 5% of W, AA, and H, respectively, initiated biologics after CD diagnosis (P = not significant). After adjusting for demographics and CD-related medications and comorbidities in Cox models, no association was found between AA and W for biological use (hazard ratio 1.19; 95% confidence interval [CI], 0.91–1.54) or H and W (hazard ratio 0.68, 95% CI, 0.45–1.02). Analyzing patients hospitalized after CD diagnosis (n = 3428) to adjust for disease severity demonstrated that H were significantly less likely to use biologics than W (hazard ratio 0.40, 95% CI, 0.22–0.74). No differences between W and AA were found.

Conclusions: Our findings suggest that differences between AA and W in exposure to immunomodulators or biologics may not exist, although they may be present in H with more severe disease. Further research is needed to confirm these findings.

Article first published online 25 February 2016.

*Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland;

AbbVie Inc., North Chicago, Illinois; and

Analysis Group Inc., Boston, Massachusetts.

Reprints: Mark H. Flasar, MD, MS, Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, 100 North Greene Street, LL, Baltimore, MD 21201 (e-mail: mflasar@medicine.maryland.edu).

M. H. Flasar is a Research Support in AbbVie, Jansen, and Given Imaging Inc. J. Chao is an employee of AbbVie and may own stock or stock options. A. B. Ozbay, at the time of this study, was an employee of AbbVie and may hold stock in AbbVie. M. Skup is an employee of AbbVie and may own stock or stock options. M. Lu is an employee of Analysis Group, which received funding from AbbVie. R. Cross receives consulting fees from/for AbbVie, participates in advisory boards for AbbVie, has research and educational support from AbbVie and Janssen, and has received fees for speaking for AbbVie.

Design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract.

All authors contributed to the development of the publication and maintained control over the final content.

Received September 15, 2015

Accepted October 14, 2015

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