Abstracts Highlight Access Barriers, CV Risks Associated With IBD Care

Barriers to timely access to care and possible cardiovascular (CV) complications associated with therapies used to treat inflammatory bowel disease (IBD), were identified by researchers and shared at the Crohn’s & Colitis Congress, the annual meeting of the Crohn’s & Colitis Foundation.

Inflammatory bowel disease is an umbrella term for Crohn disease and ulcerative colitis. Image credit: mi_viri - stock.adobe.com

Barriers to Health Care Access for Patients With IBD

Patients with IBD continue to experience challenges with accessing care, often having to skip or ration their medications as a result, which can have serious health consequences, according to 1 abstract.¹

The researchers collected responses to an anonymous 52-question nationally-distributed survey. Patients with IBD as well as caretakers of this population were asked to evaluate access to health care teams, procedures, treatments, and any accompanying barriers.

Among the 2881 patients (n = 1963; 86.1%) and caretakers (n = 318; 13.9%) who responded, most were female (n = 1559; 68.4%), dealt with the Crohn disease subtype of IBD (n = 1507; 66.1%), and had health insurance (n = 1315; 98%). Among those who were insured, 81.9% (n = 1315) had insurance provided by their employer or a union.

The main reasons patients gave for not receiving medical care for IBD were lack of appointment availability (39%), long waits for insurance approval (26%), inability to connect with medical office by phone (19%), work or other time commitments (19%), long commute to provider’s office (15%), limited office hours at medical facilities (11%), inability to find an in-network provider or hospital (9%), and lack of transportation (4%).

Patients also struggled with insurance challenges when filling prescriptions, such as waiting over 2 days to get their medication filled due to prior authorization delays (39.1%), spending more than 2 hours on the phone with their insurance company (28.1%), and lack of insurance coverage for their prescription (29.8%), whether that was due to a physician prescribing the drug off-label (26.1%) or step therapy restrictions (24.8%).

Other reported medication-related challenges included clerical errors (23.8%), the inability to receive infusions at preferred locations (13.8%), the need to make accommodations to receive medication supplies at home (10.5%), and concerns about adverse effects (7.0%). About 6% of respondents also reported that seeking a second opinion for assistance with appeal denials caused care access issues.

“IBD patients continue to experience significant access to care challenges, often having to make dangerous tradeoffs, such as skipping or rationing their medications, Continued advocacy for healthcare system and policy reform for affordable care and medications remains imperative,” the authors wrote.

Feeling forced to take their position into their own hands, patients reported making several attempts to save money, including asking their provider for a lower cost prescription (23.6%), delaying prescription filling (22.9%), not filling their prescriptions at all (20.6%), taking less of their medication (15.6%), skipping doses (15.2%), using alternative therapies (11.6%), or buying a medication from another country (5.1%).

The researchers emphasized how their results demonstrate the need for continual advocacy in health care system and policy reform to ensure affordable care and medication access for patients with IBD.

Comparison of CV Risks Associated With IBD Therapies in Older Adults

Treatment with ustekinumab (Stalera) therapy had a lower risk of all-cause mortality along with other CV outcomes compared with vedolizumab (Entyvio) therapy, according to another abstract.²

Vedolizumab and ustekinumab are common biologics prescribed to patients with moderate to severe IBD, but there is limited data on how these medications compare to one another in regard to CV safety, especially in older adults who already have an increased risk for CV events, chronic inflammation, and comorbidities.

A population-based cohort study using electronic health records on 113 million US patients sourced from the TriNetX network. For inclusion, the researchers looked for patients aged 50 years or older who were diagnosed with Crohn disease or ulcerative colitis between January 2018 and January 2024. Patients administered vedolizumab were matched 1:1 with patients administered ustekinumab (n = 5608 each).

The mean age of the whole cohort was 61.9 years, with most identifying as women (53.8%), and the median follow-up were 3.1 years.

Data show that patients treated with ustekinumab had a lower risk for all-cause mortality compared with vedolizumab users (227 vs 317 deaths; risk ratio [RR], 0.716; 95% CI, 0.606-0.846).

Additionally, patients administered ustekinumab had a lower risk of coronary revascularization (632 vs 772; RR, 0.716; 95% CI, 0.606-0.846), including percutaneous coronary intervention or coronary artery bypass grafting. These patients also demonstrated a lower risk of developing on-ST-segment elevation myocardial infarction (54 vs 81 events; RR, 0.667; 95% CI, 0.473-0.939).

Researchers did not identify significant differences in the prevalence of major adverse CV events or individual risks of stroke and acute myocardial infarction between the groups.

References

1. Jordan A, Bhat S, Harkins-Schwarz M, Ehrlich OG. Barriers to timely healthcare access for IBD patients in the U.S.: additional findings from a recent survey by the Crohn’s & Colitis Foundation. Presented at: Crohn’s & Colitis Congress 2025; February 6-8, 2025; San Francisco, CA. Abstract1960005.

2. Chan Es-Y, Polpichai N, Yang HY, et al. Comparative risk of major adverse cardiovascular events with vendolizumab vs ustekinumab in older adults with inflammatory bowel disease: a propensity-matched cohort analysis. Presented at: Crohn’s & Colitis Congress 2025; February 6-8, 2025; San Francisco, CA. Abstract 1961314.