Systematic review and meta-analysis: Prevalence, risk factors, and costs of aminosalicylate use in Crohn’s disease
<h4>Background</h4> <p>Aminosalicylates are the most frequently prescribed drugs for patients with Crohn’s disease (CD), yet evidence to support their efficacy as induction or maintenance therapy is controversial.</p> <h4>Aims</h4> <p>To quantify aminosalic...
| Hlavní autoři: | , , , , , , , , , , , |
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| Médium: | Journal article |
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Wiley
2018
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| _version_ | 1826282704070508544 |
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| author | Ma, C Dutton, SJ Cipriano, LE Singh, S Parker, CE Nguyen, TM Guizzetti, L Gregor, JC Chande, N Hindryckx, P Feagan, BG Jairath, V |
| author_facet | Ma, C Dutton, SJ Cipriano, LE Singh, S Parker, CE Nguyen, TM Guizzetti, L Gregor, JC Chande, N Hindryckx, P Feagan, BG Jairath, V |
| author_sort | Ma, C |
| collection | OXFORD |
| description | <h4>Background</h4> <p>Aminosalicylates are the most frequently prescribed drugs for patients with Crohn’s disease (CD), yet evidence to support their efficacy as induction or maintenance therapy is controversial.</p> <h4>Aims</h4> <p>To quantify aminosalicylate use in CD clinical trials, identify factors associated with use, and estimate direct annual treatment costs of therapy.</p> <h4>Methods</h4> <p>MEDLINE, Embase, and CENTRAL were searched to April 2017 for placebo-controlled trials in adults with CD treated with corticosteroids, immunosuppressants, or biologics. The proportion of patients co-prescribed aminosalicylates in placebo arms was pooled using a random effects model. Meta-regression was used to identify factors associated with aminosalicylate use. Annual treatment costs were estimated using the 2016 Ontario Drug Benefit Program.</p> <h4>Results</h4> <p>Forty-two induction and ten maintenance trials were included. The pooled proportion of patients co-prescribed aminosalicylates was 44% [95% CI: 39%-49%] in induction trials and 49% [95% CI: 35%-64%] in maintenance trials. There was substantial to considerable heterogeneity (I2=86.0%, 91.8% for induction and maintenance trials, respectively). In multivariable meta-regression, aminosalicylate use has decreased over time in induction trials (OR 0.50 [95% CI: 0.34, 0.74] per 10-year increment). Whilst a decline has been seen over time, 35% of CD patients were still using aminosalicylates in contemporary trials from the last five years. The estimated annual cost for the lowest price mesalamine formulation is approximately $32 million for the Canadian CD population.</p> <h4>Conclusions</h4> <p>Over one-third of CD patients entering clinical trials are still co-prescribed aminosalicylates. A definitive trial is needed to inform the conventional practice of using aminosalicylates as CD maintenance therapy.</p> |
| first_indexed | 2024-03-07T00:47:52Z |
| format | Journal article |
| id | oxford-uuid:854e71cc-5c35-444d-a242-9713136c5481 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T00:47:52Z |
| publishDate | 2018 |
| publisher | Wiley |
| record_format | dspace |
| spelling | oxford-uuid:854e71cc-5c35-444d-a242-9713136c54812022-03-26T21:56:44ZSystematic review and meta-analysis: Prevalence, risk factors, and costs of aminosalicylate use in Crohn’s diseaseJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:854e71cc-5c35-444d-a242-9713136c5481Symplectic Elements at OxfordWiley2018Ma, CDutton, SJCipriano, LESingh, SParker, CENguyen, TMGuizzetti, LGregor, JCChande, NHindryckx, PFeagan, BGJairath, V <h4>Background</h4> <p>Aminosalicylates are the most frequently prescribed drugs for patients with Crohn’s disease (CD), yet evidence to support their efficacy as induction or maintenance therapy is controversial.</p> <h4>Aims</h4> <p>To quantify aminosalicylate use in CD clinical trials, identify factors associated with use, and estimate direct annual treatment costs of therapy.</p> <h4>Methods</h4> <p>MEDLINE, Embase, and CENTRAL were searched to April 2017 for placebo-controlled trials in adults with CD treated with corticosteroids, immunosuppressants, or biologics. The proportion of patients co-prescribed aminosalicylates in placebo arms was pooled using a random effects model. Meta-regression was used to identify factors associated with aminosalicylate use. Annual treatment costs were estimated using the 2016 Ontario Drug Benefit Program.</p> <h4>Results</h4> <p>Forty-two induction and ten maintenance trials were included. The pooled proportion of patients co-prescribed aminosalicylates was 44% [95% CI: 39%-49%] in induction trials and 49% [95% CI: 35%-64%] in maintenance trials. There was substantial to considerable heterogeneity (I2=86.0%, 91.8% for induction and maintenance trials, respectively). In multivariable meta-regression, aminosalicylate use has decreased over time in induction trials (OR 0.50 [95% CI: 0.34, 0.74] per 10-year increment). Whilst a decline has been seen over time, 35% of CD patients were still using aminosalicylates in contemporary trials from the last five years. The estimated annual cost for the lowest price mesalamine formulation is approximately $32 million for the Canadian CD population.</p> <h4>Conclusions</h4> <p>Over one-third of CD patients entering clinical trials are still co-prescribed aminosalicylates. A definitive trial is needed to inform the conventional practice of using aminosalicylates as CD maintenance therapy.</p> |
| spellingShingle | Ma, C Dutton, SJ Cipriano, LE Singh, S Parker, CE Nguyen, TM Guizzetti, L Gregor, JC Chande, N Hindryckx, P Feagan, BG Jairath, V Systematic review and meta-analysis: Prevalence, risk factors, and costs of aminosalicylate use in Crohn’s disease |
| title | Systematic review and meta-analysis: Prevalence, risk factors, and costs of aminosalicylate use in Crohn’s disease |
| title_full | Systematic review and meta-analysis: Prevalence, risk factors, and costs of aminosalicylate use in Crohn’s disease |
| title_fullStr | Systematic review and meta-analysis: Prevalence, risk factors, and costs of aminosalicylate use in Crohn’s disease |
| title_full_unstemmed | Systematic review and meta-analysis: Prevalence, risk factors, and costs of aminosalicylate use in Crohn’s disease |
| title_short | Systematic review and meta-analysis: Prevalence, risk factors, and costs of aminosalicylate use in Crohn’s disease |
| title_sort | systematic review and meta analysis prevalence risk factors and costs of aminosalicylate use in crohn s disease |
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