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Organizations’ IBD treatment guidelines lack evidence, consensus, conflict of interest disclosures
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Inflammatory bowel disease treatment guidelines released by gastroenterological associations are often based on poor evidence, lack consensus, and most do not disclose potential conflicts of interest, according to a recent study.
Researchers evaluated the quality and methods of grading evidence, plus disclosures of conflicts of interest (COI), among 19 IBD-related guidelines released by the ACG (two relevant guidelines), the AGA (three), the BSG (three), the CAG (three) and the ECCO (eight guidelines) as of September 2012.
Across 16 evaluable guidelines with graded evidence, investigators assessed 1,070 recommendations for maintenance of remission and treatment for severe acute flares in patients with ulcerative colitis (UC), according to the AASLD grading system. Level A evidence (randomized controlled trials and/or meta-analyses) was cited by 23% of recommendations, 28% cited level B (a single randomized controlled or non-randomized trial), 36% level C (case studies, expert opinions or standard of care) and 13% level D evidence (no grade provided).
Recommendations varied across associations in several cases, including the use of infliximab, methotrexate or tacrolimus to maintain UC remission.
Sixty-one percent of guidelines did not disclose information on potential COI, while those that did said conflicts existed. An average of 11.7 COI was disclosed by 92 of 113 authors of guidelines with COI information. No significant differences were observed among associations according to the number of COI disclosed or the average number disclosed per author.
J.D. Feuerstein
“Given the current state of the guidelines, clinicians should be cautious when utilizing recommendations to improve the quality of care,” researcher J.D. Feuerstein, MD, Beth Israel Deaconess Medical Center in Boston, told Healio.com. “The different international IBD societies provide varying recommendations based on the same available evidence. … Numerous potential conflicts of interest are present in the development process, without any clear means to mitigate their potential influence. This is especially troubling when a majority of the supporting evidence is based on lower quality evidence or expert opinion. … As a result, guidelines do not necessarily provide the latest information or current practice.”
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