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      Biologic treatment of Japanese patients with inflammatory bowel disease

      research-article
      Author(s): 1 , 2 , , 3 , 4
      Publication date (Electronic):
      Journal: BMC Gastroenterology
      Publisher: BioMed Central
      Keywords: Japan, IBD, Biologic treatment

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          Abstract

          Background

          There is little information regarding the use of biologics in Inflammatory Bowel Disease (IBD) patients in Japan. The aim of this study was to determine the factors associated with the use of biologics in the treatment of Japanese patients with IBD.

          Methods

          An online survey was conducted among Japanese patients with IBD ( n = 1035). Socioeconomic as well as treatment related information was collected. Logistic regression was applied to analyze the determinants of biologic treatment.

          Results

          Younger age (≤ 40 years vs. > 65 years; OR:0.24), time since diagnosis (< 2 years vs. < 15 years; OR: 4.16), surgical history (OR:1.98) and visiting university hospitals (university hospitals vs. clinics; OR: 0.47) were associated with biologic treatment for Japanese IBD patients.

          Conclusions

          Currently, biologics have been used in younger IBD patients which may give rise to the presence of an age bias in biologic treatment. Further studies are required to confirm these results and to define appropriate IBD patients who should be treated with biologic agent.

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          Most cited references38

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          Inequalities in access to medical care by income in developed countries.

          Eddy Van Doorslaer, Cristina Masseria, Xander Koolman (2006)
          Most of the member countries of the Organization for Economic Cooperation and Development (OECD) aim to ensure equitable access to health care. This is often interpreted as requiring that care be available on the basis of need and not willingness or ability to pay. We sought to examine equity in physician utilization in 21 OECD countries for the year 2000. Using data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use. We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland. Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered.
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            Biologic Therapies and Risk of Infection and Malignancy in Patients With Inflammatory Bowel Disease: A Systematic Review and Network Meta-analysis.

            Stefanos Bonovas, Gionata Fiorino, Mariangela Allocca … (2016)
            Safety issues are a major concern for patients considering treatments for inflammatory bowel disease (IBD). We performed a systematic review and meta-analysis to determine whether biologic agents affect the risk of infection or malignancy in adults with IBD.
            Article 0 comments Cited 147 times – based on 0 reviews     Review now
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              Loss of response and need for adalimumab dose intensification in Crohn's disease: a systematic review.

              Vincent Billioud, William J Sandborn, Laurent Peyrin-Biroulet (2011)
              The objective of this study was to review loss of response and need for adalimumab dose intensification in adult and pediatric patients with Crohn's disease. Studies were identified through the electronic databases of MEDLINE and the annual meetings of Digestive Disease Week, of the United European Gastroenterology Week, and of the American College of Gastroenterology and the European Crohn's and Colitis Organization meetings. Studies evaluating loss of efficacy and/or need for dose intensification were included. Thirty-nine studies were included. The mean percentage of loss of response to adalimumab among primary responders was 18.2% and the annual risk was 20.3% per patient-year. The mean percentage of patients who required dose intensification among primary responders to adalimumab was 37% and the annual risk was 24.8% per patient-year. When considering initial responders and patients with primary non-response, the mean percentage of patients who needed an adalimumab dose escalation was 21.4% and the annual risk was 24.4% per patient-year. Pooled analysis showed that dose escalation permitted response to be regained in 71.4% and remission in 39.9% of patients. Predictors for loss of response or dose escalation were male gender, current/former smoker status, family history of inflammatory bowel disease, isolated colonic disease, extra-intestinal manifestations, 80/40  mg induction therapy, longer disease duration, greater baseline Crohn's Disease Activity Index, concomitant corticosteroid use, no deep remission at week 12, low serum trough concentrations of adalimumab, previous infliximab non-response and being previously treated with an anti-tumor necrosis factor agent. Overall, around one fifth of adult patients require dose intensification and experience a loss of response after initiation of adalimumab therapy. Adalimumab dose escalation permits response to be regained in the majority of patients.
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                Author and article information

                Contributors
                Jörg Mahlich:
                ORCID: http://orcid.org/0000-0003-1110-2793
                +49 2137 9553394 , Joerg.mahlich@gmail.com , jmahlich@its.jnj.com , mahlich@dice.hhu.de
                Katsuyoshi Matsuoka: matsuoka@fk2.so-net.ne.jp
                Rosarin Sruamsiri: r.sruamsiri@gmail.com
                Journal
                Journal ID (nlm-ta): BMC Gastroenterol
                Journal ID (iso-abbrev): BMC Gastroenterol
                Title: BMC Gastroenterology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-230X
                Publication date (Electronic): 1 November 2018
                Publication date PMC-release: 1 November 2018
                Publication date Collection: 2018
                Volume: 18
                Electronic Location Identifier: 160
                Affiliations
                [1 ]ISNI 0000 0004 0629 4353, GRID grid.497524.9, Health Economics & Outcomes Research, Janssen, ; Johnson & Johnson Platz 1, 41470 Neuss, Germany
                [2 ]ISNI 0000 0001 2176 9917, GRID grid.411327.2, Düsseldorf Institute for Competition Economics (DICE), , University of Düsseldorf, ; Düsseldorf, Germany
                [3 ]ISNI 0000 0000 9290 9879, GRID grid.265050.4, Department of Gastroenterology and Hepatology, , Toho University Sakura Medical Center, ; Sakura, Japan
                [4 ]ISNI 0000 0000 9211 2704, GRID grid.412029.c, Center of Pharmaceutical Outcomes Research, , Naresuan University, ; Phitsanulok, Thailand
                Author information
                http://orcid.org/0000-0003-1110-2793
                Article
                Publisher ID: 892
                DOI: 10.1186/s12876-018-0892-x
                PMC ID: 6211510
                PubMed ID: 30384833
                SO-VID: 476f0b90-5112-4934-99a3-bbd55acc60a4
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 7 February 2018
                Date accepted : 23 October 2018
                Funding
                Funded by: Janssen KK
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: japan,ibd,biologic treatment
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: japan, ibd, biologic treatment

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