Christopher Ma1,2, Carla Ascoytia3, Kelly P McCarrier3, Mona Martin3, Brian G Feagan2,4,5, Vipul Jairath6,7,8. 1. Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada. 2. Robarts Clinical Trials, Inc., London, ON, Canada. 3. Health Research Associates, Inc., Mountlake Terrace, WA, USA. 4. Department of Medicine, Western University, London, ON, Canada. 5. Department of Biostatistics and Epidemiology, Western University, London, ON, Canada. 6. Robarts Clinical Trials, Inc., London, ON, Canada. vjairath@uwo.ca. 7. Department of Medicine, Western University, London, ON, Canada. vjairath@uwo.ca. 8. Department of Biostatistics and Epidemiology, Western University, London, ON, Canada. vjairath@uwo.ca.
Abstract
BACKGROUND: Aminosalicylates are the most commonly prescribed therapy in Crohn's disease (CD), despite uncertainty in the evidence to support their efficacy. AIMS: To examine physicians' perspectives on aminosalicylate use for CD and explore the discordance between clinical practice and the evidence base. METHODS: A qualitative interview study was performed amongst physicians with at least 4 years of independent experience in managing CD patients. Semi-structured telephone interviews were conducted using an exploratory interview guide. Interview transcripts were thematically analyzed to elucidate concepts pertaining to treatment strategies for CD, motivations for prescribing aminosalicylates, perceived benefits and harms of aminosalicylate use, and the relationship between the evidence and real-world prescribing practices. RESULTS: A representative sample of thirty physicians from four different countries and multiple practice environments (university/teaching hospitals, public practice, private/community practice, and subspecialty gastroenterology clinics) participated. Nearly all physicians (93.3%, 28/30) reported prescribing aminosalicylates for CD. Aminosalicylates were endorsed as first-line therapy for mild CD by nearly half of participants (13/30, 43.3%). A favorable safety profile, possible efficacy in mild colonic CD, and patient reluctance to step-up to other therapies were primary motivators for aminosalicylate use. Almost half of respondents (46.7%) expressed that the evidence informing aminosalicylate efficacy in CD differed substantially from their own clinical experience. CONCLUSIONS: Physicians' beliefs about efficacy in subgroups of CD patients, safety, and patient preferences primarily motivate aminosalicylate prescription in CD. There is a lack of confidence in published clinical trials, and a desire for more robust evidence to inform 5-ASA use in CD.
BACKGROUND:Aminosalicylates are the most commonly prescribed therapy in Crohn's disease (CD), despite uncertainty in the evidence to support their efficacy. AIMS: To examine physicians' perspectives on aminosalicylate use for CD and explore the discordance between clinical practice and the evidence base. METHODS: A qualitative interview study was performed amongst physicians with at least 4 years of independent experience in managing CD patients. Semi-structured telephone interviews were conducted using an exploratory interview guide. Interview transcripts were thematically analyzed to elucidate concepts pertaining to treatment strategies for CD, motivations for prescribing aminosalicylates, perceived benefits and harms of aminosalicylate use, and the relationship between the evidence and real-world prescribing practices. RESULTS: A representative sample of thirty physicians from four different countries and multiple practice environments (university/teaching hospitals, public practice, private/community practice, and subspecialty gastroenterology clinics) participated. Nearly all physicians (93.3%, 28/30) reported prescribing aminosalicylates for CD. Aminosalicylates were endorsed as first-line therapy for mild CD by nearly half of participants (13/30, 43.3%). A favorable safety profile, possible efficacy in mild colonic CD, and patient reluctance to step-up to other therapies were primary motivators for aminosalicylate use. Almost half of respondents (46.7%) expressed that the evidence informing aminosalicylate efficacy in CD differed substantially from their own clinical experience. CONCLUSIONS: Physicians' beliefs about efficacy in subgroups of CD patients, safety, and patient preferences primarily motivate aminosalicylate prescription in CD. There is a lack of confidence in published clinical trials, and a desire for more robust evidence to inform 5-ASA use in CD.
Authors: Geert D'Haens; Filip Baert; Gert van Assche; Philip Caenepeel; Philippe Vergauwe; Hans Tuynman; Martine De Vos; Sander van Deventer; Larry Stitt; Allan Donner; Severine Vermeire; Frank J Van De Mierop; Jean-Charles R Coche; Janneke van der Woude; Thomas Ochsenkühn; Ad A van Bodegraven; Philippe P Van Hootegem; Guy L Lambrecht; Fazia Mana; Paul Rutgeerts; Brian G Feagan; Daniel Hommes Journal: Lancet Date: 2008-02-23 Impact factor: 79.321
Authors: Fabian Schnitzler; Herma Fidder; Marc Ferrante; Maja Noman; Ingrid Arijs; Gert Van Assche; Ilse Hoffman; Kristel Van Steen; Séverine Vermeire; Paul Rutgeerts Journal: Inflamm Bowel Dis Date: 2009-09 Impact factor: 5.325
Authors: L Peyrin-Biroulet; W Sandborn; B E Sands; W Reinisch; W Bemelman; R V Bryant; G D'Haens; I Dotan; M Dubinsky; B Feagan; G Fiorino; R Gearry; S Krishnareddy; P L Lakatos; E V Loftus; P Marteau; P Munkholm; T B Murdoch; I Ordás; R Panaccione; R H Riddell; J Ruel; D T Rubin; M Samaan; C A Siegel; M S Silverberg; J Stoker; S Schreiber; S Travis; G Van Assche; S Danese; J Panes; G Bouguen; S O'Donnell; B Pariente; S Winer; S Hanauer; J-F Colombel Journal: Am J Gastroenterol Date: 2015-08-25 Impact factor: 10.864
Authors: Reena Khanna; Brian Bressler; Barrett G Levesque; Guangyong Zou; Larry W Stitt; Gordon R Greenberg; Remo Panaccione; Alain Bitton; Pierre Paré; Séverine Vermeire; Geert D'Haens; Donald MacIntosh; William J Sandborn; Allan Donner; Margaret K Vandervoort; Joan C Morris; Brian G Feagan Journal: Lancet Date: 2015-09-03 Impact factor: 79.321
Authors: Johan Burisch; Daniel Bergemalm; Jonas Halfvarson; Viktor Domislovic; Zeljko Krznaric; Adrian Goldis; Jens F Dahlerup; Pia Oksanen; Pekka Collin; Luisa de Castro; Vicent Hernandez; Svetlana Turcan; Elena Belousova; Renata D'Incà; Alessandro Sartini; Daniela Valpiani; Martina Giannotta; Ravi Misra; Naila Arebi; Dana Duricova; Martin Bortlik; Kelly Gatt; Pierre Ellul; Natalia Pedersen; Jens Kjeldsen; Karina W Andersen; Vibeke Andersen; Konstantinos H Katsanos; Dimitrios K Christodoulou; Shaji Sebastian; Luisa Barros; Fernando Magro; Jóngerð Mm Midjord; Kári R Nielsen; Riina Salupere; Hendrika Al Kievit; Gediminas Kiudelis; Juozas Kupčinskas; Mathurin Fumery; Corinne Gower-Rousseau; Ioannis P Kaimakliotis; Doron Schwartz; Selwyn Odes; Laszlo Lakatos; Peter L Lakatos; Ebbe Langholz; Pia Munkholm Journal: United European Gastroenterol J Date: 2020-07-26 Impact factor: 4.623