Abstract
Background
The US Food and Drug Administration currently approves three types of anti-tumor necrosis factor α (anti-TNFα) therapy for treatment of moderate to severe Crohn’s disease. There are no guidelines to clarify which of the drugs may be better suited to individual clinical scenarios.
Aims
We gathered national data on the prescribing pattern, comfort levels, and algorithms gastroenterologists use for management of their biologic-requiring Crohn’s disease patients.
Methods
An internet survey was mailed to members of the American Gastroenterology Association. Responses were separated into “non-expert” and “expert” physician groups on the basis of whether a practice consisted of >50% of patients with inflammatory bowel disease. We compared experts with non-experts with regard to the use of the three anti-TNF agents, attitudes regarding their relative efficacy, and their experience with adverse events.
Results
Of 3,990 eligible gastroenterologists, 473 replied in full (11.9%). Sixty (12.6%) respondents met the criterion for IBD expert physician. Experts were comfortable using both immunomodulators and anti-TNFα therapy. Community physicians were equally comfortable prescribing 6-mercaptopurine, azathioprine, infliximab, and adalimumab, but less comfortable than experts with methotrexate (56 vs. 86%, P < 0.05) and certolizumab (68 vs. 89%, P < 0.05). Expert physicians were much more likely to have encountered adverse reactions to anti-TNFα therapy.
Conclusions
Our results suggest that experts are more comfortable using a broader array of medical therapy than non-expert physicians. Although both groups had similar concerns regarding side-effects of anti-TNFα therapy, expert physicians were much more likely to have managed a broad range of complications in their patient population.
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References
Targan SR, Hanauer SB, van Deventer SJ, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med. 1997;337:1029–1035.
Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359:1541–1549. doi:S0140-6736(02)08512-4[pii]10.1016/S0140-6736(02)08512-4.
Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130:323–333. doi:quiz591S0016-5085(05)02315-2[pii]10.1053/j.gastro.2005.11.030.
Sandborn WJ, Hanauer SB, Rutgeerts P, et al. Adalimumab for maintenance treatment of Crohn’s disease: results of the CLASSIC II trial. Gut. 2007;56:1232–1239. doi:gut.2006.106781[pii]10.1136/gut.2006.106781.
Sands BE, Blank MA, Patel K, et al. Long-term treatment of rectovaginal fistulas in Crohn’s disease: response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol. 2004;2:912–920. doi:S1542356504004148[pii].
Sandborn WJ, Feagan BG, Stoinov S, et al. Certolizumab pegol for the treatment of Crohn’s disease. N Engl J Med. 2007;357:228–238. doi:357/3/228[pii]10.1056/NEJMoa067594.
Schwartz DA. The PRECiSE 2 trial of certolizumab pegol, a new PEGylated anti-TNF agent, in the treatment of Crohn’s disease: an interview with David A Schwartz, 13 June 2007. Biologics. 2008;2:126–128.
Mushlin AI, Ghomrawi H. Health care reform and the need for comparative-effectiveness research. N Engl J Med. 2010;362:e6.
Donovan M, Lunney K, Carter-Pokras O, et al. Prescribing patterns and awareness of adverse effects of infliximab: a health survey of gastroenterologists. Dig Dis Sci. 2007;52:1798–1805.
Feagan BG, Rochon J, Fedorak RN, et al. Methotrexate for the treatment of Crohn’s disease. The North American Crohn’s Study Group Investigators. N Engl J Med. 1995;332:292–297.
Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362:1383–1395.
El Mourabet M, El-Hachem S, Harrison JR, et al. Anti-TNF antibody therapy for inflammatory bowel disease during pregnancy: a clinical review. Curr Drug Targets. 2010;11:234–241.
Mahadevan U, Kane S. Use of infliximab in pregnancy. Am J Gastroenterol. 2010;105:219. author reply 219-20.
Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006;131:283–311.
Oussalah A, Roblin X, Laharie D, et al. Tumour necrosis factor antagonists and inflammatory bowel diseases: a national practice survey. Aliment Pharmacol Ther. 2009;30:854–863.
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Swaminath, A., Lebwohl, B., Capiak, K.M. et al. Practice Patterns in the Use of Anti-Tumor Necrosis Factor Alpha Agents in the Management of Crohn’s Disease: A US National Practice Survey Comparing Experts and Non-Experts. Dig Dis Sci 56, 1160–1164 (2011). https://doi.org/10.1007/s10620-010-1530-9
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DOI: https://doi.org/10.1007/s10620-010-1530-9