Original research: Influence of comorbidities on treatment considerations for first-line biologic prescribing in patients with inflammatory bowel disease in the UK |
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| Authors: | Ayesha Akbar Tim Orchard Nick Powell Christian Selinger Clare tibbatts |
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| Affiliation: | 1. St Mark''s Hospital and Academic Institute, Harrow, London, UK ; 2. Department of Metabolism, Digestion and Reproduction, Imperial College Healthcare NHS Trust, London, UK ; 3. Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK ; 4. Department of Gastroenterology, St James''s University Hospital, Leeds, West Yorkshire, UK ; 5. Gastroenterlogy, Cardiff and Vale University Health Board, Cardiff, South Glamorgan, UK |
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| Abstract: | BackgroundAnti-tumour necrosis factor (anti-TNF) therapies are the most commonly used biologics for inflammatory bowel disease (IBD), but for patients with a comorbidity, newer agents may be a more appropriate treatment choice.AimsTo investigate the impact of comorbidities in patients with IBD, on first-line biologic prescribing habits of IBD-specialist healthcare practitioners in the UK.MethodsIBD-specialist physicians and nurses were asked to answer an online survey, considering different prescribing scenarios in ulcerative colitis (UC) and Crohn’s disease (CD). Respondents could indicate a preference for anti-TNFs or newer biologics, both in the absence and presence of 10 common comorbidities.ResultsA total of 120 IBD-specialist healthcare professionals (HCPs) completed the survey. In the absence of comorbidities, anti-TNFs were favoured; infliximab was the preferred first-line biologic in both UC and CD (43% and 37% of respondents, respectively). On introducing comorbidities, the largest shift in prescribing behaviour was for vedolizumab, with preference increasing by 27% and 21%, compared with infliximab, which fell by 14% and 9% in UC and CD, respectively. Chronic/recurring infection (46%), congestive heart failure (≤44%) and malignancies (≤43%) were the most commonly selected comorbidities for vedolizumab treatment.ConclusionsClinicians adapt their biologic prescribing habits in patients with IBD with comorbidities, considering known contraindications and precautions. A preference for vedolizumab is evident in many cases, however, for several comorbid scenarios, including demyelinating disorders, chronic obstructive pulmonary disease and malignancy, anti-TNFs are prescribed despite known risks. It is important that continual re-evaluation of the IBD treatment landscape is undertaken by HCPs, in alignment with recommendations in published guidelines. |
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| Keywords: | crohn''s disease inflammatory bowel disease colorectal cancer functional bowel disorder IBD clinical |
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