Biological and steroid use in relationship to quality measures in older patients with inflammatory bowel disease: a US Medicare cohort study

BMJ Open
Sophia L JohnsonMaureen A Smith

Abstract

To examine the frequency and predictors of antitumour necrosis factor (TNF) use, and to describe steroid utilisation among US patients with inflammatory bowel disease (IBD) aged 65 years and older prior to the publication of a new Medicare quality measure calling for the use of anti-TNFs and other steroid-sparing agents. Retrospective cohort study. This study utilised 2006-2009 claims data for a national sample of Medicare beneficiaries. Patients with IBD (>1 claim for ICD codes 555.xx, 556.xx) without anti-TNF contraindications, enrolled in Medicare parts A and B ≥12 months and part D ≥6 months were included (n=8502). We estimated incidence rate ratios (IRR) and 95% CIs predicting new anti-TNF therapy using multivariable Poisson regression. This nationally representative study of older patients with IBD estimated that only 3.7% received anti-TNFs. New anti-TNF use (1.4%) was associated with younger age, absence of Medicaid coverage, hospitalisation, and higher preceding use of burst (IRR=2.35, CI 1.59 to 3.47) and maintenance steroids (IRR=2.40, CI 1.05 to 5.48). Among anti-TNF users, we observed high rates of concurrent maintenance steroid use (19%). Anti-TNF use was very low in this population of older patients with IBD and,...Continue Reading

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Mar 2, 2016·Journal of Crohn's & Colitis·Ashwin N AnanthakrishnanSiew C Ng
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May 11, 2018·Intestinal research·Saurabh KediaVineet Ahuja
Apr 29, 2021·Frontline Gastroenterology·Jonathan BlackwellRichard Pollok

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