Title: Treatment Sequences, Outcomes, Healthcare Utilization and Costs in Patients with
Inflammatory Bowel Diseases Requiring Advanced Treatment—Real World Comparative
Effectiveness from German Claims Data
Version: 0 Date: 29 Mar 2025
Reviewer's report:
This was a longitudinal retrospective observational study examining treatment effectiveness of
advanced therapies in IBD from German claims data. A total of 2948 patients were included.
Vedolizumab was shown to be more effective than infliximab in UC with regards to longer
persistence and less inadequate response. In Crohn's disease, both ustekinumab and vedolizumab
showed superior persistence to infliximab over 3 years. It was concluded that although anti-
TNF agents are most commonly used, vedolizumab was a preferred choice given its superior
persistence.
Comments:
1. In the abstract, please outline what 'WIG2' stands for
2. Could patients have had an advanced therapy more than 1 year prior to the index year, and
hence not be naïve? E.g they had a longer treatment break
3. Many patients have another immunological condition diagnosed with the CD or UC, including
rheumatological conditions. How did you confirm whether the use of an advanced therapy was
not for the e.g. rheumatological condition, as opposed to an IBD diagnosis?
4. What if steroid use was for a non-IBD reason? As such, ‘inadequate responders’ may be
incorrectly classified. There are many other reasons why patients may use steroid medications,
particularly if they have co-existing rheumatological conditions.
5. The use of a concomitant immunomodulator would be important to capture and describe, as
this would impact on anti-TNF persistence. This should be included and described.
6. When reviewing data from other countries, do they mandate that anti-TNF has to be a first
line therapy? Would this impact on prescribing practices?
A major limitation is the lack of data on oral small molecules. There are multiple publications
with large numbers of patients that examine persistence of advanced therapies. A more up-to-
date analysis that included more patients on tofacitinib and upadacitinib (+/- S1P inhibitors in
UC) would be more interesting.
Title: Treatment Sequences, Outcomes, Healthcare Utilization and Costs in Patients with
Inflammatory Bowel Diseases Requiring Advanced Treatment—Real World Comparative
Effectiveness from German Claims Data
Version: 0 Date: 29 Mar 2025
Reviewer's report:
This was a longitudinal retrospective observational study examining treatment effectiveness of
advanced therapies in IBD from German claims data. A total of 2948 patients were included.
Vedolizumab was shown to be more effective than infliximab in UC with regards to longer
persistence and less inadequate response. In Crohn's disease, both ustekinumab and vedolizumab
showed superior persistence to infliximab over 3 years. It was concluded that although anti-
TNF agents are most commonly used, vedolizumab was a preferred choice given its superior
persistence.
Comments:
1. In the abstract, please outline what 'WIG2' stands for
2. Could patients have had an advanced therapy more than 1 year prior to the index year, and
hence not be naïve? E.g they had a longer treatment break
3. Many patients have another immunological condition diagnosed with the CD or UC, including
rheumatological conditions. How did you confirm whether the use of an advanced therapy was
not for the e.g. rheumatological condition, as opposed to an IBD diagnosis?
4. What if steroid use was for a non-IBD reason? As such, ‘inadequate responders’ may be
incorrectly classified. There are many other reasons why patients may use steroid medications,
particularly if they have co-existing rheumatological conditions.
5. The use of a concomitant immunomodulator would be important to capture and describe, as
this would impact on anti-TNF persistence. This should be included and described.
6. When reviewing data from other countries, do they mandate that anti-TNF has to be a first
line therapy? Would this impact on prescribing practices?
A major limitation is the lack of data on oral small molecules. There are multiple publications
with large numbers of patients that examine persistence of advanced therapies. A more up-to-
date analysis that included more patients on tofacitinib and upadacitinib (+/- S1P inhibitors in
UC) would be more interesting.
Please review this paper.
user
Title: Treatment Sequences, Outcomes, Healthcare Utilization and Costs in Patients with
Inflammatory Bowel Diseases Requiring Advanced Treatment—Real World Comparative
Effectiveness from German Claims Data
Version: 0 Date: 29 Mar 2025
Reviewer's report:
This was a longitudinal retrospective observational study examining treatment effectiveness of
advanced therapies in IBD from German claims data. A total of 2948 patients were included.
Vedolizumab was shown to be more effective than infliximab in UC with regards to longer
persistence and less inadequate response. In Crohn's disease, both ustekinumab and vedolizumab
showed superior persistence to infliximab over 3 years. It was concluded that although anti-
TNF agents are most commonly used, vedolizumab was a preferred choice given its superior
persistence.
Comments:
1. In the abstract, please outline what 'WIG2' stands for
2. Could patients have had an advanced therapy more than 1 year prior to the index year, and
hence not be naïve? E.g they had a longer treatment break
3. Many patients have another immunological condition diagnosed with the CD or UC, including
rheumatological conditions. How did you confirm whether the use of an advanced therapy was
not for the e.g. rheumatological condition, as opposed to an IBD diagnosis?
4. What if steroid use was for a non-IBD reason? As such, ‘inadequate responders’ may be
incorrectly classified. There are many other reasons why patients may use steroid medications,
particularly if they have co-existing rheumatological conditions.
5. The use of a concomitant immunomodulator would be important to capture and describe, as
this would impact on anti-TNF persistence. This should be included and described.
6. When reviewing data from other countries, do they mandate that anti-TNF has to be a first
line therapy? Would this impact on prescribing practices?
A major limitation is the lack of data on oral small molecules. There are multiple publications
with large numbers of patients that examine persistence of advanced therapies. A more up-to-
date analysis that included more patients on tofacitinib and upadacitinib (+/- S1P inhibitors in
UC) would be more interesting.
assistant