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Patterns and predictors of long-term retention of inflammatory bowel or rheumatoid disease patients on innovator infliximab: an analysis of a Canadian prescriptions claims database

Authors Baer PA, Aumais G, Ewara EM, Khraishi M, Marrache AM, Panaccione R, Wade JP, Marshall JK

Received 17 April 2018

Accepted for publication 26 July 2018

Published 18 September 2018 Volume 2018:12 Pages 1805—1814


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Philip A Baer,1 Guy Aumais,2 Emmanuel M Ewara,3 Majed Khraishi,4 A Marilise Marrache,5 Remo Panaccione,6 John P Wade,7 John K Marshall8

1Baer Weinberg MPC, Scarborough, ON, 2Department of Medicine, Université de Montréal, Gastro-enterology Unit, Hôpital Maisonneuve-Rosemont, Montréal, QC, 3Government Affairs and Market Access, Janssen Inc., Toronto, ON, 4Medical Affairs, Janssen Inc., Toronto, ON, 5Faculty of Medicine, Division of Rheumatology, Memorial University of Newfoundland and Nexus Clinical Research, St John’s, NL, 6Inflammatory Bowel Disease Unit, Department of Medicine, University of Calgary, Calgary, AB, 7Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, BC, 8Department of Medicine, Division of Gastroenterology, McMaster University and Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada

Background: Long-term effectiveness is an important factor when considering treatment decisions.
Objective: To determine the long-term retention patterns of Canadian inflammatory bowel disease (IBD) and rheumatologic disease (RD) patients, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, treated with innovator infliximab (IFX) and to assess the impact of year-over-year cumulative IFX exposure on retention in both patient populations.
Patients and methods: This analysis used a Canadian longitudinal prescription claims database to measure retention on IFX over a period of 5 years. Twelve-month unadjusted odds ratios of retention by time on IFX were calculated for the overall cohort, and within-group comparisons evaluated differences according to age, sex, region, insurance coverage, use of concomitant immunosuppressant therapy, indication (RD cohort only), and previous biologic experience. Between-group analyses compared unadjusted 5-year retention among the same variables. Variables that were independently associated with longer retention on IFX were identified using multivariable regression.
Results: Seven thousand eight hundred and six IBD patients and 2,935 RD patients on stable treatment with IFX were included in the analysis. Sixty-nine percent of IBD patients and 66% of RD patients were retained on IFX after 1 year and 33% and 29%, respectively, were retained after 5 years. Moreover, the probability of being retained on IFX significantly increased with cumulative time on IFX. Independent predictors of 5-year retention included sex, region, and type of insurance coverage among IBD patients and region, type of insurance, prior biologic therapy, and specific indication among RD patients. Patients with IBD were 17% more likely to be retained on IFX over 5 years compared to patients with RD.
Conclusion: Real-world Canadian IBD and RD patients on IFX have good overall long-term treatment retention. Previous duration of IFX treatment predicts better future retention, and this knowledge could help inform treatment decisions when patients have been stable on IFX treatment for varying periods of time.

Keywords: administrative database, inflammation, anti-TNF drugs, biologicals, retention

Erratum for this paper has been published

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