Treatment Patterns Associated with Cushing Disease in a Large US Managed Care Health Plan

Presentation Number: SAT-0645
Date of Presentation: June 21st, 2014

Tanya Burton*1, Elisabeth LeNestour2, Maureen P Neary3 and William H Ludlam3
1Optum, Waltham, MA, 2inVentiv Health Clinical, France, 3Novartis Pharmaceuticals Corporation, East Hanover, NJ


OBJECTIVE: To describe treatment patterns for Cushing disease (CD).

METHODS: A retrospective cohort study design was used to analyze administrative claims data of commercial health plan enrollees with evidence of Cushing disease (CD) between 2007-2011. Children and adult CD cases were identified using a Cushing syndrome (CS) diagnosis code (ICD-9: 255.0) and at least one code for a CD-related diagnosis or procedure (e.g., pituitary neoplasm or hypophysectomy). CD cases were observed for 6 months before and at least 6 months after their first CD-related claim. Medication use during this time was described descriptively.

RESULTS: 885 enrollees met the CD selection criteria. Mean (SD) age was 42 (14) years, 75% were female. Median follow-up time was 2.4 years with a minimum of 6 months and a maximum of 5.5 years. During the study period, 208 (24%) had evidence of a hypophysectomy, 611 (69%) a CD-related medication, and 241 (27%) had neither. Only 23 (3%) had evidence of a bilateral adrenalectomy. Of the 208 with a hypophysectomy, 179 (86%) had evidence of pituitary supplementation.  Among the 611 with a CD-related medication (with and without surgery), 336 (55%) had at least one claim levothyroxine, followed by 262 (43%) with hydrocortisone and 250 (41%) with at least one sex hormone (testosterone, estrogen, and/or progestin). Antifungals were filled by 210 (34%) with a CD-related medication, and 57 (27%) of all antifungal fills were for oral ketoconazole. Less common medications included 73 (12%) with 9-alpha fludocortisone, 62 (10%) with cabergoline, and 19 (3%) with bromocriptine. Only three CD cases (<1%) had a fill for mitotane.  Nearly all CD cases, 848 or 96%, had at least one concomitant medication filled during the study period, of which 684 (81%) had two or more different types. Common concomitant fills included 766 (90%) with at least one antibiotic sometime during the study period, followed by 480 (57%) with an antihypertensive, 432 (51%) with an antidepressant or mood stabilizer, 274 (32%) with a hyperglycemic, and 263 (31%) with an osteoporosis medication including calcium and vitamin D.

CONCLUSION: The majority of identified CD cases were treated with hypophysectomy and/or pituitary supplementation. Bilateral adrenalectomy was rare and pituitary irradiation was not found in our database. Levothyroxine was the most common drug filled. Of the antifungals filled, more than a quarter was for oral ketoconazole.


Disclosure: TB: Researcher, Novartis Pharmaceuticals. MPN: Employee, Novartis Pharmaceuticals, Employee, Novartis Pharmaceuticals, Employee, Novartis Pharmaceuticals. WHL: Employee, Novartis Pharmaceuticals. Nothing to Disclose: EL