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201 ESTABLISHING PATIENT PREFERENCE AMONGST ANTI-TNF AGENTS IN THE TREATMENT OF CROHN'S DISEASE B Kaila, R Panaccione BACKGROUND: While the etiology of Crohn's disease remains obscure the production of tumor necrosis factor alpha (TNF alpha) is thought to have a central role in initiation and propagation of disease. Three anti-TNF agents with similar side effect profiles have been shown to be effective in the induction of remission and maintenance of response: Infliximab (administered intravenously in a medical setting and the only available anti-TNF agent), Adalimumab (self-administered subcutaneously) and Certolizumab (subcutaneous administration by a health care provider).
Division of Gastroenterology, University of Calgary, Calgary, Alberta
AIM: We aim to determine patient preference in terms of mode of administration of anti-TNF agents (subcutaneous versus intravenous) and potential factors that may predict their preference.
METHOD: All adult Crohn's patients (new diagnosis or follow-up) being assessed by a gastroenterologist in the Calgary Health Region at the Foot Hills Medical Centre were eligible. They were offered a short questionnaire to complete during their clinic visit. Patients were excluded if they lacked English language skills, failed to provide consent or had previous exposure to anti-TNF therapy.
RESULTS: To date a total of 75 patients (25 male; 50 female) between the ages of 26 to 45 years (58%) with mild to moderate Crohn's disease (with 37% having greater than 15 years of disease) have completed the questionnaire. Of those who expressed preference, the three most important treatment attributes impacting choice of therapy were side-effects, efficacy and route of administration; and the least was cost of therapy. The majority of patient preferred self-administered subcutaneous injections (51%) followed by subcutaneous administration by a health care provider (31%) and intravenous administration in a medical setting (17%) (one patient did not respond). The bulk of the patients felt that their choice was most influenced by convenience of the therapy and the least disruptive option.
CONCLUSION: It appears that self-administered subcutaneous injections (Adalimumab) are preferred by patients due to a convenient dosing regimen. Thus, prescribing may be impacted by patient preference and ultimately influential in lobbying for availability of preferred therapies.