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IBD Patients Accept Risks of Medical Therapies to Maintain Remission
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Patients with inflammatory bowel disease reported they were willing to accept the fairly high risks of lymphoma and serious infections associated with medical therapies to maintain remission and avoid relapse, according to results from a survey study.
“Prior studies have demonstrated that patients are willing to accept relatively high risks of serious adverse events … to improve current symptoms of IBD,” Meenakshi Bewtra, MD, MPH, PhD, from University of Pennsylvania, and colleagues wrote. “However, little is known about how much patients value future time in remission relative to future risks of [serious adverse events].”
Meenakshi Bewtra
To evaluate how much risk patients accept from medical therapy to avoid relapse, Bewtra and colleagues performed a discrete-choice experiment in which 202 IBD patients completed a survey looking at competing hypothetical treatment scenarios with varying serious adverse event (SAE) risks and time to relapse. Patients were randomly assigned to receive one of eight surveys, each of which included questions about eight of 32 possible treatment options.
“We used estimated trade-off rates to calculate the maximum acceptable risk … of medication-related SAE risks that would exactly offset the perceived benefit of avoiding a future IBD relapse,” Bewtra and colleagues wrote.
Almost all of the respondents had IBD for at least 1 year (median disease duration, 11 years), two-thirds had ulcerative colitis and 70% reported being in remission or having minimal symptoms.
The survey responses showed that patients were willing to accept up to a 28% chance of a serious infection and a 1.8% chance of lymphoma to avoid a relapse over the next 5 years. Results were comparable for avoiding relapse for 10 years, but dropped to 11% and 0.7%, respectively, for avoiding relapse for 1.5 years.
Subgroup analysis showed that patients with active symptoms were less willing to accept medication-associated risks for time in remission; to prevent relapse for 1.5 years, patients in remission were willing to accept a 15.6% risk for infection or 1.1% risk for lymphoma compared with patients with active symptoms who were willing to accept 8.5% and 0.5% respective risks.
“Our findings suggest that patients are willing to accept risks exceeding those currently associated with combination anti-TNF plus immunosuppressant therapy if such treatment provided sustained remission for at least 5 years,” the researchers concluded. “These data suggest that more aggressive treatment strategies that induce and sustain a remission may be welcomed by patients, and provide insights in understanding patient preferences to inform more patient-centered decisions.” – by Adam Leitenberger
Disclosures: The researchers reports no relevant financial disclosures.
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