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MEDICAL MANAGEMENT OF INFLAMMATORY BOWEL DISEASE; PATTERNS OF INFLIXIMAB USE AMONGST CANADIAN GASTROENTEROLOGISTS
J Jones1, R Panaccione1, M Russell2, R Hilsden1 1Department of Medicine, University of Calgary, Calgary, Alberta and 2Department of Community Health Sciences, Epidemiology and Biostatistics, University of Calgary, Calgary, Alberta
BACKGROUND: The last decade has been characterized by an increase in the number of biological agents avaialbe to treat inflammatory bowel disease (IBD). Infliximab was approved by Health Canada for the treatment of Crohn’s disease (CD) in 2001 and for ulcerative colitis (UC) in 2006. Despite this there is no available literature evaluating physician perception and individual practice pattern using this agent.
Objectives: 1) To describe the clinical patterns of Infliximab use in the treatment of medically refractory IBD by Canadian physicians and 2) to identify specific factors which may influence a physician’s decision to initiate Infliximab therapy.
METHODS: A nationally distributed, self-report questionnaire, designed in accordance with Tailored Design Methodology, was distributed in three waves to all practicing clinicians captured in the 2007 membership of the Canadian Association of Gastroenterology (CAG). A sample size of 45 percent was required to provide a 95 percent confidence interval for obtained estimates and to maximize the precision and generalizability of survey results.
RESULTS: An overall response rate of 72 percent (333/466) was obtained. The majority of respondents were between the ages of 30 and 59 years with a broad distribution of the number of years in clinical practice. 70 percent of the clinicians surveyed in this study see more than 50 percent IBD in their clinical practice. Most clinicians prescribe Infliximab at an initial dose of 5 mg per kilogram (97%), prescribe loading doses at 0, 2 and 6 weeks (88%) and pre-medicate with corticosteroids (74%). Most respondents administer maintenance infusions at 8 week intervals (89%), co-administer immunosuppressive agents (81%) and continue Infliximab “indefinitely”, as long as effective and well tolerated (76%). There was significant variability with respect toperceived indication and perceived risk versus benefit of Infliximab.
CONCLUSIONS: Most Canadian gastroenterologists exhibit similar practice patterns with respect to the use of Infliximab for induction and maintenance therapy of IBD. Common barriers were identified with respect to the initiation of Infliximab therapy. The development of more targeted educational programs are needed to help guide clinicians in specific aspects of IBD patient care.