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[Formula presented] Fig. 1. Evolution du nombre de consultations pour troubles psychiques et pour les pathologies chroniques temoins en 2020 et 2021 Copyright © 2022
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Introduction: Subcutaneous biotherapies (SCB) are used in the management of inflammatory bowel diseases (IBD). Aims & Methods: The aims were to evaluate the feasibility in using a medication dispense data to identify these patients and to study the impact of COVID-19 on SCB prescription. LRx contains all anonymized medication dispenses prescribed in outpatient care in a representative panel of French retails pharmacies, including data of near 40 million patients. Each patient having at least a dispense of SCB or synthetic targeted treatment reimbursed in psoriasis, IBD, and chronic inflammatory rheumatologic disease was selected in 2019. An algorithm was constructed using different steps in order to classify the patient in one of these diseases (weighted score according to the step: mono-indication or common indication shared among product, prescriber's specialist, specific tracking drugs to one of these disease prescribed prior or co-prescribed with the treatment of interest). We numbered 190,640 patients of which 16% with IBD under SCB. We described IBD population in terms of demographics, SCB and co-treatment prescribed in 2019 (at least one delivery) in 2019. The impact of COVID-19 on SCB initiation was studied during the lockdown period in France (W12-W19 2020). Results: 30,788 IBD patients were under SCB in France in 2019 (52% female;5.7%, 44.1%, 34.6%, 12.0%, 2.5% of patients split in the following age classes: 0-19, 20-39, 40-59, 60-74, ≥75 years, respectively). Patients were mainly under adalimumab (82.8%), followed by ustekinumab (11.8%), and golimumab (7.3%). Azathioprine represented the most frequent immunosuppressant delivered (19.9%) followed by methotrexate (5%). Oral and rectal corticosteroids was prescribed at least once in 2019 for 45.5 and 10.4% of the patients, respectively. Oral corticosteroids delivered at least thrice concerned 6.7% of the patients. Mesalazine and sulfasalazine were delivered for 21.5% and 0.7% of the patients, respectively. The impact of SCB initiation during the lockdown period due to COVID-19 had significantly decrease by 20% compared to 2019 (p=0.003). Conclusion: The algorithm was able to identify IBD patients under SCB and could provide meaningful information in order to describe the drug survival, the change in management at the national level (for patients followed in outpatient care, only), and the impact of COVID-19. These results need to be confirmed using another source of data containing clinical diagnosis to validate the algorithm in its ability to identify chronic inflammatory diseases.
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Background: Discriminating chronic inflammatory diseases under biotherapy and/or targeted synthetic treatments (B/TST) using medico-administrative databases are challenging but required for medico-economic analyses focusing on these diseases. Objectives: The objective was to evaluate the feasibility of using a medication dispense data in order to identify patients with chronic inflammatory diseases under B/TST in outpatient care setting and evaluate the impact of COVID-19 in France Methods: LRx contains all anonymized medication dispenses prescribed in outpatient care in a representative panel of French retails pharmacies, including data of near 40 million patients. Patients having at least one B/TST delivered in 2019 were selected. An algorithm was constructed using different steps, including a machine learning step by transfer learning applied in patient classified as having a rheumatologic condition in order to differentiate rheumatoid arthritis (RA) from spondyloarthritis (SA). We numbered 190,640 patients, of which 87.8% were classified in one of the following diseases: RA, SA, psoriatic arthritis (PA), psoriasis, inflammatory bowel diseases (IBD) (extrapolated data to France). Descriptive analysis was performed. The impact of COVID-19 on biotherapy initiation was evaluated during the lockdown period (W2-W19 2020) in these different conditions. Results: Among the 167,468 patients under B/TST, 20.7%, 18.4%, 6.5%, 37.9% and 16.5% were considered as having a psoriasis, IBD, PA, RA, and SA, respectively. Female patients were more frequent in RA and PA (≥ 60%);younger (< 20 years) and older patients (74 years) were found in patients with IBD (5.7%) and RA (12.6%), respectively. Contrasting with IBD, SA, and RA patients were mainly under anti-TNF treatment (≥ 90% for IBD and SA, 73.5% for RA), psoriasis and PA patients received a range of broadly well-balanced of B/TST. Among the immunosuppressant, methotrexate was mostly prescribed in RA (58.4%), PA (34.1%), and psoriasis (14.1%), and azathioprine in IBD (19.9%). Oral corticosteroid delivered at least 4 times in 2019 were mostly found to be associated with a RA condition (28%). A significant decrease of biotherapy initiation was observed during the lockdown in France in patients with IBD (-20%, p=0.03) and psoriasis (-54%, p<0.0001), not significant decrease in patients with SA (-6%) and increase in RA patients (+23%). Conclusion: The algorithm was able to identify patients with chronic inflammatory diseases under B/TST delivered in outpatient care and will allow to follow-up its management and study the COVID-19 impact on biotherapy initiation. An external validation needs to be performed .
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Background: During the epidemic's peak of COVID-19, scientific societies published recommendations on biotherapy and targeted synthetic treatment (B/TST) use in patients with chronic articular inflammatory diseases, inflammatory bowel diseases, and psoriasis. Objectives: The objective was to evaluate the impact of COVID-19 in France on initiation and renewal of B/TST. Methods: LRx contains all anonymized medication dispenses prescribed in outpatient care in a representative panel of French retails pharmacies, including data of near 40 million patients. The impact of B/TST initiation and renewal were studied using 2019 as reference and dispense deliveries data of pharmacies with regular flew in order to perform the comparison. B/TST considered were abatacept, anti-TNF, anti-IL6, anti-IL17, anti-IL12/23 or anti-IL23, JAK inhibitors (JAKi) and other classes such as aprelimast, aminosalicylates (AS), hydroxychloroquine (HCQ), and methotrexate (MTX). A treatment initiated was defined as a treatment not delivered in the past 12 months, and conversely for a treatment renewal. Results were presented as raw one and expressed in percentage of patients having at least one B/TST delivery in each therapeutic classes of interest in 2020 compared to 2019 used as reference year (period from week 12 to week 19 considered and corresponding to the lockdown period in France). Results: During the lockdown period, a decrease in initiation was observed for patients treated with: abatacept (405 in 2019 vs 227 in 2020: -44%, p<0.001), anti-TNF (1156 vs 1058, -31%, p<0.001), anti-IL17 (415 vs 206, -50%, p<0.001), anti-IL12-23 (395 vs 339, -12%, p=0.16), JAKi (289 vs 174, -39%, p=0.006), contrasting with an increase for Tociliumab (117 vs 445, +152%, p=0,01). We found a decrease of 7% (2171 vs 2015, p=0,35), 44% (405 vs 227, p<0.001), 30% (3430 vs 2390, p p<0.001) of AS, aprelimast and MTX initiation, respectively, and an increase of 173% (1708 vs 4671, p=0.11) of HCQ initiation. No decrease for the renewal of B/TST was observed Conclusion: During the epidemic's peak, initiation of AS, MTX, biotherapies (except for tocilizumab), and JAKi dramatically decreased without impacting their renewal. Two treatments were mainly initiated, tocilizumab probably due to a switch from intravenous to subcutaneous injection and HCQ in relation to its presumably effect on COVID-19. Overall, recommendations from scientific societies have been followed.
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Introduction Plusieurs sociétés savantes, dont la SFR et l’EULAR, ont émis des recommandations sur le renouvellement et l’initiation des biothérapies (B) et des traitements synthétiques ciblés (TSC) pour les patients souffrant d’une maladie inflammatoire chronique (MIC) au pic de l’épidémie. Nous avons étudié le profil de délivrances de ces traitements durant la période de confinement en France. Matériels et méthodes Nous avons utilisé la source de données d’IQVIA, LTD, Longitudinal Treatment Dynamics, qui comprend les données de délivrances d’un échantillon représentatif de 45 % des officines françaises. Toutes les B/TSC prescrites par les spécialités habilitées à le faire et délivrées en ville ont été prises en considération. L’impact national des renouvellements et des initiations de ces traitements a été étudié pendant la période de confinement (Semaine S12 à S19) et comparé à la même période en 2019 à partir des données de délivrance des pharmacies ayant transmis leur donnée régulièrement pendant la période d’intérêt (36 % des pharmacies françaises). Les résultats sont présentés à partir des données brutes et exprimés en pourcentage de patients ayant eu une délivrance des classes thérapeutiques d’intérêt en 2020 comparé à 2019 utilisée comme année de référence (Fig. 1). Les classes prises en considération ont été les biothérapies (anti-TNF, anti-IL6, anti-IL17, anti-IL23), les traitements synthétiques ciblés (aprélimast, inhibiteurs de JAK), ainsi que des traitements susceptibles d’être utilisés dans les MIC, à savoir les aminosalicylés, l’hydroxychloroquine et le méthotrexate. Résultats Pendant la période S12 à S19, 48341 et 53944 patients ont eu au moins une délivrance d’un B/TSC respectivement en 2019 et 2020. La période de confinement n’a pas eu d’impact sur les renouvellements de B/TSC comparés à 2019 quelque soit le type de prescripteur ou la molécule prescrite. En revanche pour les initiations, elles ont diminué pour la majorité des classes suivantes dont les anti-TNF (−31 %), les anti-IL17 (− 50 %), les anti-IL23 (−12 %) et les TSC (−42 %) sauf pour les ant-IL6 (+152 %, augmentation concernant exclusivement le tocilizumab). Concernant les autres traitements, les initiations ont diminué pour les aminosalicylés (−7 %) et le méthotrexate (−30 %) et fortement augmenté pour l’hydroxychloroquine (+173 %). Conclusion Au pic de l’épidémie, les initiations par aminosalicylés, méthotrexate, biothérapie (sauf tocilizumab) et TSC ont fortement diminué sans impact sur les renouvellements de ces traitements. Deux molécules ont été fortement prescrites en initiation, le tocilizumab probablement lié au switch vers la voie sous cutanée et l’hydroxychloroquine dans l’hypothèse d’un effet sur la COVID-19. Les recommmandations préconisées par les différentes sociétés savantes semblent avoir été respectées pour ce qui concerne les B/TSC. Des analyses par MIC devraient être réalisées pour compléter ces données.