Stephan R Vavricka1, Sanja Radivojevic1, Christine N Manser2, Pascal Frei3, Emanuel Burri4, Michael Fried2, Alain Schoepfer5, Laurent Peyrin-Biroulet6, Pierre Michetti7, Gerhard Rogler2, Luc Biedermann8. 1. Division of Gastroenterology & Hepatology, Triemli Hospital, Zurich, Switzerland. 2. Division of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland. 3. Division of Gastroenterology & Hepatology, Seespital Horgen, Horgen, Switzerland. 4. Division of Gastroenterology & Hepatology, Medical University Hospital Liestal, Liestal, Switzerland. 5. Division of Gastroenterology & Hepatology, University Hospital Lausanne, Lausanne, Switzerland. 6. Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy-Brabois, Vandoeuvre-lès-Nancy, France. 7. Clinic de la source, Gastroenterology, Lausanne, Switzerland. 8. Division of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland. Electronic address: luc.biedermann@usz.ch.
Abstract
BACKGROUND: In recent years several trials have addressed treatment challenges in Crohn's disease. Clinical trials however, represent a very special situation. AIMS: To perform a cross-sectional survey among gastroenterologists on the current clinical real life therapeutic approach focussing on the use of biologics. METHODS: A survey including six main questions on clinical management of loss of response, diagnostic evaluation prior to major treatment changes, preference for anti-tumour necrosis factor (TNF) agent, (de-)escalation strategies as well as a basic section regarding personal information was sent by mail to all gastroenterologists in Switzerland (n=318). RESULTS: In total, 120 questionnaires were analysed (response rate 37.7%). 90% of gastroenterologists in Switzerland use a thiopurine as the first step-up strategy (anti-TNF alone 7.5%, combination 2.5%). To address loss of response, most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the biologic and adding a thiopurine. In case of prolonged remission on combination therapy, the thiopurine is stopped first (52.6%) after a mean treatment duration of 15.7 months (biologic first in 41.4%). CONCLUSIONS: Everyday clinical practice in Crohn's disease patients appears to be incongruent with clinical data derived from major trials. Studies investigating reasons underlying these discrepancies are of need to optimize and harmonize treatment.
BACKGROUND: In recent years several trials have addressed treatment challenges in Crohn's disease. Clinical trials however, represent a very special situation. AIMS: To perform a cross-sectional survey among gastroenterologists on the current clinical real life therapeutic approach focussing on the use of biologics. METHODS: A survey including six main questions on clinical management of loss of response, diagnostic evaluation prior to major treatment changes, preference for anti-tumour necrosis factor (TNF) agent, (de-)escalation strategies as well as a basic section regarding personal information was sent by mail to all gastroenterologists in Switzerland (n=318). RESULTS: In total, 120 questionnaires were analysed (response rate 37.7%). 90% of gastroenterologists in Switzerland use a thiopurine as the first step-up strategy (anti-TNF alone 7.5%, combination 2.5%). To address loss of response, most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the biologic and adding a thiopurine. In case of prolonged remission on combination therapy, the thiopurine is stopped first (52.6%) after a mean treatment duration of 15.7 months (biologic first in 41.4%). CONCLUSIONS: Everyday clinical practice in Crohn's diseasepatients appears to be incongruent with clinical data derived from major trials. Studies investigating reasons underlying these discrepancies are of need to optimize and harmonize treatment.
Authors: Peter C Church; Jeffrey Hyams; Frank Ruemmele; Lissy de Ridder; Dan Turner; Anne M Griffiths Journal: Can J Gastroenterol Hepatol Date: 2018-06-12