Abstract
Introduction: Tumor necrosis factor antagonists (anti-TNF) therapies are used for the management of moderate to severe inflammatory bowel disease (IBD). Anti-TNF combination therapy, with immunomodulators, has been shown to reduce immunogenicity, especially for infliximab, improve treatment success rate and patient outcomes. We evaluated factors associated with gastroenterologists adherence to anti-TNF combination therapy.Methods: A retrospective cohort study was performed to evaluate the adherence of gastroenterologists (n = 14), at an inflammatory bowel disease center, to anti-TNF combination therapy. Records of patients who received Infliximab (n = 137) or adalimumab (n = 152) were obtained and their ordering physicians' data was analyzed. Gastroenterologists were divided into six groups according to their age and interest in IBD. The baseline characteristics of their patients were also obtained.Results: The proportion of patients on combination therapy in the young gastroenterologists group was higher than those in the senior gastroenterologists group for both infliximab (83.2 vs. 55.6%, respectively, P < 0.001) and adalimumab (59 vs. 30.8%, respectively, P < 0.001). Gastroenterologists with interest in inflammatory bowel disease (IBD interest group) had also more proportion of patients on adalimumab combination therapy compared to gastroenterologists with no interest in IBD (non-IBD interest group) (61.7 vs. 35.2%, respectively, P < 0.001). Gastroenterologists who were both young and have interest in IBD had more proportion of patients on combination therapy than those who were senior or had no interest in IBD for both infliximab (89.4 vs. 63.4%, respectively, P < 0.001) and adalimumab (75.9 vs. 33%, P < 0.001). The IBD interest group was also requesting more antidrug antibody level tests than those in the non-IBD interest group (41.4 vs. 12.3 tests, respectively, P < 0.001).Conclusion: Young gastroenterologists are more likely to prescribe anti-TNF infliximab and adalimumab combination therapy than senior gastroenterologists. In addition, gastroenterologists with IBD interest are more likely to prescribe adalimumab combination therapy than gastroenterologists with no IBD interest. Moreover, young gastroenterologists who have interest in IBD are more likely to prescribe both infliximab and adalimumab combination therapy than senior gastroenterologists or those with no IBD interest. In addition, gastroenterologists with IBD interest requested more anti-TNF serum drug concentrations and antidrug antibody level tests than those with no IBD interest.
Highlights
Tumor necrosis factor antagonists therapies are used for the management of moderate to severe inflammatory bowel disease (IBD)
Based on the available evidence (SONIC and Ulcerative colitis (UC)-SUCCESS trials), both American Gastroenterology Association (AGA) and European Crohn’s and Colitis Organization (ECCO) guidelines support the use of infliximab combination therapy over infliximab monotherapy, in inducing and maintaining clinical remission in patients with moderate to severe IBD [1, 3, 8, 9]
A recent study done by Roblin et al, showed that combination therapy can result in better clinical outcomes without clinical failure or unfavorable pharmacokinetics at 24 months in patients with IBD who experienced an immune-mediated loss of response with first anti-TNF [13]
Summary
Tumor necrosis factor antagonists (anti-TNF) therapies are used for the management of moderate to severe inflammatory bowel disease (IBD). Tumor necrosis factor antagonists (anti-TNF) therapies are considered to be an effective treatment for moderate-tosevere inflammatory bowel disease (IBD) [1,2,3,4]. Based on the available evidence (SONIC and UC-SUCCESS trials), both American Gastroenterology Association (AGA) and European Crohn’s and Colitis Organization (ECCO) guidelines support the use of infliximab combination therapy over infliximab monotherapy, in inducing and maintaining clinical remission in patients with moderate to severe IBD [1, 3, 8, 9]. While AGA guidelines support the use of adalimumab combination therapy over monotherapy, especially for patients who have developed loss of response to anti-TNF [1, 2]. We did this study to evaluate the adherence of our gastroenterologists to anti-TNF combination therapy and understand factors that can be associated with their adherence
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