P393 Patient and physician perspectives on the management of inflammatory bowel disease: Role of steroids in the context of biologic therapy
A. Afzali1, A. Armuzzi2, Y. Bouhnik3, B. Bressler4, A. Hart5, D. Rubin6, M. Sans7, B. Siegmund8, D. Sninsky9
1*All authors are IBD Global Assessment of Patient Unmet Needs Survey (GAPPS) Steering Committee members (listed αbetically), 1The Ohio State University Wexner Medical Center, Inflammatory Bowel Disease, Columbus, USA, 2Fondazione Policlinico A. Gemelli IRCCS - Universita’ Cattolica, Gastroenterology, Rome, Italy, 3Inserm et Université Paris, Gastroenterology, Paris, France, 4Gastroenterology, Univeristy of British Columbia, Vancouver BC, Canada, 5Gastroenterology, St. Mark’s Hospital, London, UK, 6Gastroenterology- Hepatology and Nutrition, University of Chicago, Chicago, USA, 7Centro Médico Teknon, Gastroenterology, Barcelona, Spain, 8Gastroenterology- Infectiology and Rheumatology, Charité – Universitätsmedizin Berlin, Berlin, Germany, 9Gastroenterology, Digestive Disease Associates, Gainesville, USA
Background
Corticosteroids are a mainstay of inflammatory bowel disease (IBD) treatment but are not as effective as maintenance therapy and prolonged exposure is associated with significant morbidities. We assessed real-world management of IBD using an international online survey of patients (patients) and physicians and present results related to steroid use for IBD.
Methods
The online survey was conducted in Canada, France, Germany, Italy, Spain, UK, and the USA. The mixed-recruitment methodology was used: patients were recruited by physicians, pt advocacy groups, and panels; physicians were recruited by recruitment agencies and panels. Eligible patients were adults with Crohn’s disease (CD) or ulcerative colitis (UC) (targeted 1:1 ratio CD:UC) who had received IBD treatment but had not had surgery for UC. Eligible physicians were gastroenterologists who had treated ≥12 CD patients and ≥12 UC patients (≤70% with a disease of mild severity) in the prior month and were responsible for treatment decisions.
Results
Surveys were completed by 2398 IBD patients (1368 CD, 1030 UC) and 654 physicians. Mean ages were 43 y and 45 y for patients with CD and UC, respectively; 60% and 55% were female. Most patients (93% CD, 78% UC) had moderate/severe IBD per clinical criteria; 71% and 47%, respectively, had ever required hospitalisation. Physicians had a mean monthly caseload of 42.9 CD patients and 43.3 UC patients, and 62.4%–67.2% of their IBD patients had moderate/severe disease. Biologic therapy was currently used by 50% of CD patients and 32% of UC patients, consistent with results for physicians (54% CD, 43% UC). Most patients (69% CD, 58% UC) reported a loss of response (LOR) to prior treatments, and most physicians reported that their patients experienced a LOR to biologic therapy fairly/very frequently (66% CD, 56% UC). Approximately 75% of IBD patients had ever used steroids for their IBD; steroid use of ≥4 or ≥6 months in the past year was reported by 35% and 18% of CD patients, respectively, and by 40% and 19% of UC patients. Physicians reported that 40% and 14% of their IBD patients used steroids for ≥4 or ≥6 months in the past year. Among patients currently receiving steroid therapy, many (48% CD, 42% UC) were concerned about any steroid use, and two-thirds reported wanting to stop steroid treatment as soon as the disease was under control. Only 27% of physicians reported a concern about any steroid use; approximately half reported a concern about ≥4 months of steroid use per year.
Conclusion
This international survey demonstrated that steroid use is prevalent and LOR to biologics is common among moderate/severe IBD patients. There were differences in pt and physician perception of steroid use; many physicians believed ≥4 months of steroid use per year was not a concern. A significant unmet need remains for treatments that provide sustained control of IBD.