Systematic Assessment of Items Influencing Crohn's Disease Patient's Preferences in Selecting an Anti-TNF Agent (Choose TNF Trial)

Abstract

Background and Aims: The three anti-TNF agents infliximab (IFX), adalimumab (ADA) and certolizumab pegol (CZP) have demonstrated similar efficacy in induction and maintenance of response and remission in Crohn's disease (CD) treatment. Given the comparability of these drugs, patient's preferences may influence the choice of the product. However, data on patient's preferences for choosing anti-TNF agents are lacking. We therefore aimed to assess the CD patient's appraisal to select the drug of his choice and to identify factors guiding this decision. Methods: A prospective survey among anti-TNF-naive CD patients was performed. Patients were provided a description of the three anti-TNF agents focusing on indication, application mode (s.c. vs. i.v.), application time intervals, setting of application (hospital vs. private practice vs. patient's home), average time to apply the medication per month, typical side effects, and the scientific evidence of efficacy and safety available for every drug. Patients answered a questionnaire consisting of 17 questions, covering demographic, disease-specific, and medication data. Results: Hundred patients (47f/53m, mean age 45±16 years) completed the questionnaire. Disease duration was 5 years in 62% of patients. Disease location was ileal in 33%, colonic in 40%, and ileocolonic in 27%. Disease phenotype was inflammatory in 68%, stenosing in 29%, and internally fistulizing in 3% of patients. Additionally, 20% had perianal fistulizing disease. Patients were already treated with the following drugs: mesalamines 61%, budesonide 44%, prednisone 97%, thiopurines 78%, methotrexate 16%. In total, 30% had already heard about IFX, 20% about ADA, and 11% about CZP. Thirty-six percent voted for treatment with ADA, 28% for CZP, and 25% for IFX, whereas 11% were undecided. The following factors influenced the patient's decision for choosing a specific anti-TNF drug (several answers possible): side effects 76%, physician's recommendation 66%, application mode 54%, efficacy experience 52%, time to spend for therapy 27%, patient's recommendations 21%, interactions with other medications 12%. The single most important factor for choosing a specific anti-TNF was (1 answer): side effect profile 35%, physician's recommendation 22%, efficacy experience 21%, application mode 13%, patient's recommendations 5%, time spent for therapy 3%, interaction with other medications 1%. Conclusions: The majority of patients preferred anti-TNF syringes to infusions. The safety profile of the drugs and the physician's recommendation are major factors influencing the patient's choice for a specific anti-TNF drug. Patient's issues about safety and lifestyle habits should be taken into account when prescribing specific anti-TNF formulations.