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dc.contributor.authorLee WJ
dc.contributor.authorBriars L
dc.contributor.authorLee TA
dc.contributor.authorCalip GS
dc.contributor.authorSuda KJ
dc.contributor.authorSchumock GT
dc.date.accessioned2016-12-15T21:35:19Z
dc.date.available2016-12-15T21:35:19Z
dc.date.issued2016-10
dc.identifier.bibliographicCitationLee, W. J., Briars, L., Lee, T. A., Calip, G. S., Suda, K. J. and Schumock, G. T. Top-down versus Step-up Prescribing Strategies for Tumor Necrosis Factor Alpha Inhibitors in Children and Young Adults with Inflammatory Bowel Disease. Inflammatory Bowel Diseases. 2016. 22(10): 2410-2417. doi: 10.1097/MIB.0000000000000880.en_US
dc.identifier.issn1078-0998
dc.identifier.urihttp://hdl.handle.net/10027/21410
dc.descriptionThis is a non-final version of an article published in final form in Lee, W. J., Briars, L., Lee, T. A., Calip, G. S., Suda, K. J. and Schumock, G. T. Top-down Versus Step-up Prescribing Strategies for Tumor Necrosis Factor Alpha Inhibitors in Children and Young Adults with Inflammatory Bowel Disease. Inflammatory Bowel Diseases. 2016. 22(10): 2410-2417. DOI:10.1097/MIB.0000000000000880.en_US
dc.description.abstractBACKGROUND: Early initiation of tumor necrosis factor-alpha inhibitor (TNFI) therapy for children and young adults with inflammatory bowel disease (IBD) is not well described. METHODS: We conducted a retrospective cohort study of children and young adults (≤24 yr) newly diagnosed with IBD using health insurance claims from 2009 to 2013. The conventional "step-up" approach was defined as TNFI initiation >30 days after first IBD medication prescription, whereas the "top-down" approach was defined as new TNFI prescription within 30 days of first IBD medication prescription. Switching rates, time to initiation, discontinuation, and adherence to TNFIs were compared between the 2 strategies. RESULTS: A total of 11,962 IBD patients were identified. Among 3300 TNFI users, 1298 (39.3%) were treated with the top-down approach, whereas 2002 (60.7%) were treated with the step-up approach. Top-down approach use increased from 31.4% to 49.8% during the 5-year period, and under this approach, most patients were treated with TNFIs alone. Time to TNFI initiation was shorter for patients diagnosed in more recent years. Patients treated with the top-down strategy had lower rates of corticosteroid use (32.5% versus 94.2%) compared with step-up treatment but presented a higher rate of TNFI discontinuation. The 2 strategies both exhibited high adherence (mean proportion of days covered: 83.7%-95.4%). CONCLUSIONS: Early TNFI initiation increased over time for children and young adults with IBD and was related to lower rates of corticosteroid use compared with the conventional approach. However, the higher rate of TNFI discontinuation under the top-down approach requires further examination.en_US
dc.publisherLippincott, Williams & Wilkinsen_US
dc.subjectInflammatory bowel diseaseen_US
dc.subjectpediatric inflammatory bowel diseaseen_US
dc.subjectbiologic therapiesen_US
dc.subjectmedication patternsen_US
dc.subjecttumor necrosis factor-alpha inhibitorsen_US
dc.titleTop-down versus Step-up Prescribing Strategies for Tumor Necrosis Factor Alpha Inhibitors in Children and Young Adults with Inflammatory Bowel Disease.en_US
dc.typeArticleen_US


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