The Administrative Prevalence and Pharmacotherapy of Chronic Inflammatory Bowel Diseases, 2012–2020

Ulcerative colitis (UC) and Crohn’s disease (CD) are chronic inflammatory bowel diseases (IBD) with high prevalence and morbidity. The highest prevalence reported for UC is 0.51% in Norway; for MC it is 0.32% in Germany and Canada (1). The treatment of chronic IBD is based on immunomodulation and immunosuppression. Corticosteroids and long-term immunomodulatory drugs such as azathioprine and methotrexate are used, as are biologic agents and 5-aminosalicylates (2).

Methods

This study was based on nationwide outpatient drug prescription data in accordance with § 300 paragraph 2 of the German Social Code V (SGB V) and outpatient claims data in accordance with § 295 of the SGB V. The annual administrative prevalence (2012–2020) was calculated based on the percentage of CD and UC patients within the population of statutory health-insured individuals residing in Germany. Individuals were considered to have one of the diseases in question if they had a confirmed diagnosis in at least two quarters of 1 year (ICD-10-GM code for CD: K50; for UC: K51). The annual total number of insured persons was taken from the KM6 statistics of the German Federal Ministry of Health (rhttps://www.bundesgesundheitsministerium.de/themen/krankenversicherung/zahlen-und-fakten-zur-krankenversicherung/mitglieder-und-versicherte.html). The prescription prevalence of the drugs was determined per year based on the number of patients with at least one prescription per 1000 affected individuals with diagnosed disease.

Results

The administrative prevalence of UC rose from 0.30% in 2012 to 0.38% in 2020 and of CD from 0.26% in 2012 to 0.33% in 2020. At 0.57% (UC) and 0.49% (CD), the highest prevalence (2020) was seen in 65- to 69- and in 55- to 59-year-olds, respectively (Figure). In 2020, 52.7% of individuals with UC and 59.3% with CD were female. Mesalazine had by far the highest prescription prevalence in UC compared to other drugs, remaining nearly unchanged in the period 2012–2020 (–5%) (Table). For CD, the use of mesalazine declined by 29%. The number of prescriptions of azathioprine for UC fell by 32% during the observation period, while that of methotrexate remained nearly unchanged. For CD, the number of prescriptions of azathioprine went down by 41%, that of methotrexate by 7%. Prednisolone and prednisone were prescribed less often in UC (–18%), while oral budesonide, on the other hand, was prescribed more often (+33%). For MC, both prednisolone and prednisone (–21%) as well as budesonide (–11%) were prescribed less frequently.

Figure

Annual administrative prevalence per age group for ulcerative colitis (UC) and Crohn’s disease (CD) in 2012 and 2020; data in percent

Table

Annual prescriptions of mesalazine, azathioprine, methotrexate, budesonide, systemic corticosteroids, and biologics in ulcerative colitis and Crohn’s disease*

The prescription prevalence of biologics rose in UC approximately 3.5-fold from 29.3 per 1000 persons with UC (2012) to 103.1 (2020). Vedolizumab was prescribed increasingly often, while the number of prescriptions for adalimumab increased less and infliximab prescriptions remained relatively unchanged from 2015/2016. In CD patients, the prescription prevalence of biologics rose 2.5-fold from 79.1 per 1000 persons with CD (2012) to 199.8 (2020). In particular adalimumab and ustekinumab were more frequently prescribed; in 2020, adalimumab was the most commonly prescribed biologic, followed by infliximab and ustekinumab.

Discussion

Over the 9-year study period, the administrative prevalence of chronic IBD in Germany showed a continuous rise. This rise reflects the prevailing direction of prevalence trends in Western industrialized nations (3). Global population-based data show a stabilization in incidence for Western Europe and North America (1). This rise in administrative prevalence can be best explained by the accumulaton of disease cases with low mortality and stable incidence (3). A possible decline in disease activity in older age and the resulting decrease in the need for care might explain why these diseases are less frequently coded in this group of people. The reported administrative prevalence may differ from the actual prevalence in the population. These prescription data confirm observations made in other countries, where potent biologics with a specific action are more frequently used and corticosteroids that have a stronger side effects profile less so (4). However, it is not possible to measure the quality of the treatments as such on the basis of prescription frequency.

The shift from prescribing systemic to local corticosteroids in UC may be due to the authorization in 2016 of a budesonide formulation for mild and moderate UC disease activity that allows the release of budesonide in the large intestine. Despite limited efficacy in CD (5), mesalazine showed the highest active agent-specific prescription prevalence in this patient group over the entire observation period. However, this fell by 4% on average per year. Overall, the percentage of individuals with UC who were prescribed the drugs investigated here remained largely constant at 63.5% in the period 2012–2020, whereas the percentage of CD patients prescribed these drugs declined from 61.8% to 59.1%.

Karsten H. Weylandt, Astrid Wiese, Adelheid Jung, Christoph Schmöcker, Daniel C. Baumgart, Felicia Turowski, Claudia Kohring, Kerstin Klimke, Manas K. Akmatov, Jörg Bätzing, Dawid Pieper, Jakob Holstiege

Division of Medicine, Department of Gastroenterology, Metabolism and Oncology, Ruppin General Hospital, Brandenburg Medical School, Neuruppin, Germany (Weylandt, Wiese, Jung, Schmöcker, Turowski), [e-mail]

Faculty of Health Sciences, Joint faculty of the University of Potsdam, the Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, Germany (Weylandt, Wiese, Schmöcker, Pieper)

Division of Gastroenterology and Hepatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (Baumgart)

Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany (Kohring, Klimke, Akmatov, Bätzing, Holstiege)

Institute for Health Services and Health System Research, Rüdersdorf, Germany (Pieper)

Center for Health Services Research, Brandenburg Medical School, Rüdersdorf, Germany (Pieper)

Conflict of interest statement

DCB received consultancy fees and/or speaker’s honoraria as well as reimbursement of travel expenses and/or congress fees and/or support for the organization of events from Amgen, AbbVie, Janssen Cilag, Pfizer, Galapagos, Takeda, Lilly, BMS, Merz, Astra Zeneca, Canon, Fuji, Ferring, Dr. Falk, Nestlé, Tillots, Biogen, Galapagos, Pharmacosmos, BMS, and Celltrion. He is a member of Scientific Advisory Boards von Janssen Cilag, Merz, Astra Zeneca, Canon, Lilly, Fuji, Ferring, Dr. Falk, Nestlé, Tillots, Pfizer, AbbVie, Lilly, Biogen, Galapagos, Pharmacosmos, BMS, Celltrion, and Biogen and advisory board member at DGVS, ECCO, AGA, and UEG.

KHW received event support/speaker’s honoraria from Celltrion, Microtech Endoscopy, Dr. Falk Pharma, Pentax Medical, Sanofi, Daiichi Sankyo, and Lilly.

The remaining authors declare that no conflict of interests exists.

Manuscript submitted on 4 February 2024, revised version accepted on 25 June 2024.

Translated from the original German by Christine Rye.

Cite this as:
Weylandt KH, Wiese A, Jung A, Schmöcker C, Baumgart DC, Turowski F, Kohring C, Klimke K, Akmatov MK, Bätzing J, Pieper D, Holstiege J: The administrative prevalence and pharmacotherapy of chronic inflammatory bowel diseases, 2012–2020. Dtsch Arztebl Int 2024; 121: 847–8. DOI: 10.3238/arztebl.m2024.0138

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