IBD treatment preferences primarily driven by abdominal pain avoidance
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Treatment preferences varied widely among patients with inflammatory bowel disease but were largely influenced by a desire for reduction in abdominal pain, according to data from the P-POWER IBD study presented at the ACG Annual Scientific Meeting.
Corey A. Siegel, MD, MS, section chief of gastroenterology and hepatology, co-director of the Inflammatory Bowel Disease Center and professor of medicine at Dartmouth-Hitchcock Medical Center, and colleagues used an online cross-sectional survey to collect data on treatment preferences from 400 patients aged 18 to 78 years with Crohn’s disease (54%) or ulcerative colitis (46%). The patients were asked to choose between hypothetical treatments to determine what patients prioritized when selecting a therapy.
“Our conclusions are that patients with IBD have very strong treatment preferences, but patient preferences varied significantly; they really are heterogenous,” Siegel said during a virtual poster presentation.
In the survey, the researchers asked patients to choose between treatments described by six attributes, including administration, risk for mild or moderate side effects, bowel urgency, fatigue, risk for serious infections and impact on abdominal pain, to determine which attributes were most important when selecting treatment. The researchers estimated the Relative Attribute Importance (RAI) scores and maximum acceptable risk of mild-to-moderate side effects using a mixed multinomial logit model.
“When patients are given a series of these discrete choice experiments, it begins to emerge what attributes are driving their decisions,” Siegel said. “In doing that with multiple patients over time, we can see what really are the most important attributes that drive decision making for medical therapy.”
Results showed that abdominal pain was the most important factor in patient treatment preferences (RAI, 33.4%), followed by the risk for side effects (RAI, 26.8%), risk for serious infections (RAI ,15.7%), treatment administration (RAI, 9.7%), fatigue (RAI, 8.8%) and bowel urgency (RAI, 5.7%).
Siegel and colleagues also found that patients with Crohn’s disease considered abominable pain more important than those with ulcerative colitis, whereas patients with ulcerative colitis considered bowel urgency more important than patients with Crohn’s disease (P < .05 for both).
Furthermore, the researchers found that patients would accept an additional 19% risk for mild or moderate side effects to reduce abdominal pain from severe to moderate and an additional 31% risk if the pain was reduced to mild.
“So, patients really are willing to tolerate certain side effects as long as they’re getting significant improvement of their symptoms,” Siegel said. “Finally, individual preferences should drive decision making so that patients are provided with the treatment that they value most.”
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Siegel C, et al. IBD patients’ treatment preferences are heterogeneous, but largely affected by the avoidance of abdominal pain and side effects. Presented at: ACG Annual Scientific Meeting; oct. 22-27, 2021; Las Vegas (hybrid meeting).
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