How Do Patients Decide Among Biologics for Inflammatory Bowel Disease? Interview with:

Christopher V. Almario, MD, MSHPM</strong> Assistant Professor of Medicine Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center Cedars-Sinai Center for Outcomes Research and Education Los Angeles, CA

Dr. Christopher V. Almario

Christopher V. Almario, MD, MSHPM
Assistant Professor of Medicine
Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center
Cedars-Sinai Center for Outcomes Research and Education
Los Angeles, CA What is the background for this study?

Response: Recent drug approvals have increased the availability of biologic therapies for inflammatory bowel disease (IBD). However, the growing number of biologics has also made it more difficult for both patients and healthcare providers to navigate treatment options and to ultimately choose the most appropriate therapy.

In this study, we wanted to examine patient decision-making surrounding IBD biologic therapies using conjoint analysis, which is a form of tradeoff analysis that determines how respondents make complex decisions by presenting them with competing product profiles. Here, we quantified the relative importance of 9 biologic therapy attributes (e.g., how the medicine works, how the medicine is received, long-term effectiveness, side-effect profile, etc.) in the decision-making process. What are the main findings?

Response: We recruited 640 patients total to complete the conjoint survey, among whom 304 had ulcerative colitis (UC) and 336 had Crohn’s disease. We found that the decision-making process differed between those with UC and Crohn’s disease. For UC patients, long-term remission rates, route and frequency of administration, and lymphoma risk were the most important factors when they were choosing among the medicine options. Crohn’s disease patients, on the other hand, valued short-term improvement rates, lymphoma risk, and route and frequency of administration in their decision-making process. Biologic attributes such as risk of rash and fatigue as well as mechanism of action were less important factors for both UC and Crohn’s disease patients.

It is important to remember, though, that the above results were from UC and Crohn’s disease patient groups taken as a whole; an individual may not necessarily value the same attributes as the larger group. So, we tried to see if we could predict who would value medicine effectiveness, side-effect profile, or route and frequency of administration as the most important factor in their decision-making process. Here, we found that patient demographics (e.g., age, sex, race/ethnicity, etc.) and IBD characteristics (e.g., duration and severity of IBD, prior medication use, etc.) largely were not predictive of decision-making. What should readers take away from your report?

Response: Overall, it seems that UC and Crohn’s disease patients have different priorities when faced with choosing among the biologic options. More importantly, though, readers should realize that no two patients are alike. We simply cannot presume what a patient will prefer in a biologic medication based on their demographics and IBD history. What recommendations do you have for future research as a result of this study?

Response: Because of the highly individualized decision-making process, our group is currently creating a tailored online decision tool that will support patients individually when they choose among available IBD biologic therapies. The website will include a conjoint exercise that will create a personalized “report card” that shows the biologic medicine characteristics that are most important to each patient. They can then share the report with their provider, which will then spark a more informed discussion and facilitate selection of the ‘best’ biologic option for the patient. In future research studies, we then plan on testing whether use of this online decision tool improves patient satisfaction, shared-decision making, medication compliance, and IBD outcomes when compared to usual care. Thank you for your contribution to the community.

Citation: Abstract presented at the 2016 American College of Gastroenterology

Poster 1188: Examining Patient Decision-Making Surrounding Biologic Therapies in Inflammatory Bowel Disease: Insights from a Conjoint Analysis Survey (Almario CV, Keller M, Mosadeghi S, et al.)

Study supported by Takeda Pharmaceuticals U.S.A., Inc.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 22, 2016 by Marie Benz MD FAAD