According to the results of a recent survey study published in The American Journal of Gastroenterology, patients with inflammatory bowel disease (IBD) reported they were willing to accept the fairly high risks of lymphoma and serious infections related with medical therapies to maintain remission and avoid disease relapse. The study is titled “Inflammatory Bowel Disease Patients’ Willingness to Accept Medication Risk to Avoid Future Disease Relapse.”
Crohn’s disease (CD) and ulcerative colitis (UC) are relapsing conditions with no known medical cure. Clinical trials and treatment guidelines emphasize early aggressive management in IBD, including the use of immunosuppressant medications or the addition of a biologic to an immunosuppressant medication (combination therapy), with the goal of preventing future complications.
“Prior studies have demonstrated that patients are willing to accept relatively high risks of serious adverse events … to improve current symptoms of IBD,” wrote Meenakshi Bewtra, MD, MPH, PhD, from University of Pennsylvania, and colleagues according to a recent news release. “However, little is known about how much patients value future time in remission relative to future risks of [serious adverse events].”
With the aim of quantifying IBD patients’ willingness to accept medication risk to avoid future disease relapse, the research team conducted a discrete choice experiment (DCE) — a survey-research approach that quantifies preferences for the features of healthcare services or medical therapies by asking respondents to choose among competing hypothetical treatments. A total of 202 patients with IBD completed the survey looking at competing hypothetical treatment scenarios with varying serious adverse event (SAE) risks and time to relapse. Patients were randomized to receive one of eight surveys, each including questions about eight of 32 possible treatment options.
“We used estimated trade-off rates to calculate the maximum acceptable risk … of medication-related SAE risks that would exactly offset the perceived benefit of avoiding a future IBD relapse,” explained the research team.
The results revealed that to avoid a disease relapse over the next 5 years, IBD patients were willing to accept an average of a 28% likelihood of developing a serious infection, and an average of 1.8% likelihood of developing lymphoma. There was no significant change in the results when patients were offered 10 years until their next disease relapse, although the values were lower (11 and 0.7%, respectively) when offered 1.5 years until the next disease relapse. Interestingly, patients with active disease were found to be less willing to accept the medication-associated risk for time in remission when compared to patients already in clinical remission.
“Our findings suggest that patients are willing to accept risks exceeding those currently associated with combination anti-TNF plus immunosuppressant therapy if such treatment provided sustained remission for at least 5 years,” concluded the authors. “These data suggest that more aggressive treatment strategies that induce and sustain a remission may be welcomed by patients, and provide insights in understanding patient preferences to inform more patient-centered decisions.”