Physicians’ Perspectives on Cost, Safety, and Perceived Efficacy Determine Aminosalicylate Use in Crohn’s Disease
Aminosalicylates are the most commonly prescribed therapy in Crohn’s disease (CD), despite uncertainty in the evidence to support their efficacy.
To examine physicians’ perspectives on aminosalicylate use for CD and explore the discordance between clinical practice and the evidence base.
A qualitative interview study was performed amongst physicians with at least 4 years of independent experience in managing CD patients. Semi-structured telephone interviews were conducted using an exploratory interview guide. Interview transcripts were thematically analyzed to elucidate concepts pertaining to treatment strategies for CD, motivations for prescribing aminosalicylates, perceived benefits and harms of aminosalicylate use, and the relationship between the evidence and real-world prescribing practices.
A representative sample of thirty physicians from four different countries and multiple practice environments (university/teaching hospitals, public practice, private/community practice, and subspecialty gastroenterology clinics) participated. Nearly all physicians (93.3%, 28/30) reported prescribing aminosalicylates for CD. Aminosalicylates were endorsed as first-line therapy for mild CD by nearly half of participants (13/30, 43.3%). A favorable safety profile, possible efficacy in mild colonic CD, and patient reluctance to step-up to other therapies were primary motivators for aminosalicylate use. Almost half of respondents (46.7%) expressed that the evidence informing aminosalicylate efficacy in CD differed substantially from their own clinical experience.
Physicians’ beliefs about efficacy in subgroups of CD patients, safety, and patient preferences primarily motivate aminosalicylate prescription in CD. There is a lack of confidence in published clinical trials, and a desire for more robust evidence to inform 5-ASA use in CD.
KeywordsCrohn’s disease Aminosalicylates Mesalamine Sulfasalazine
This research was conducted in a collaboration between Health Research Associates, Inc. and Robarts Clinical Trials, Inc.
CM was involved in data analysis, manuscript drafting, and editing. CA and MM performed data acquisition and analysis and manuscript editing. KPM contributed to study design, data acquisition and analysis, and manuscript editing. BGF was involved in study concept and design, data analysis, and manuscript editing. VJ performed study concept and design, data analysis, manuscript drafting and editing, study supervision. VJ is acting as the article guarantor.
This work was not specifically supported by any funding agency in the public, commercial, or not-for-profit sectors. Christopher Ma is supported by a Clinician Fellowship from the Canadian Institutes of Health Research and the Canadian Association of Gastroenterology. Vipul Jairath receives salary support from the John and Susan McDonald Endowed Chair at Western University, London, Ontario, Canada
Compliance with ethical standards
Conflict of interest
Christopher Ma has no conflicts of interest to declare. Carla Ascoytia, Kelly McCarrier, and Mona Martin are employed by Health Research Associates (HRA). HRA received funding to conduct the interviews and analyze the qualitative data but the authors have no additional individual conflicts of interest to declare. Brian Feagan has received grant/research support from Millennium Pharmaceuticals, Merck, Tillotts Pharma AG, AbbVie, Novartis Pharmaceuticals, Centocor Inc., Elan/Biogen, UCB Pharma, Bristol-Myers Squibb, Genentech, ActoGenix, and Wyeth Pharmaceuticals Inc.; consulting fees from Millennium Pharmaceuticals, Merck, Centocor Inc., Elan/Biogen, Janssen-Ortho, Teva Pharmaceuticals, Bristol-Myers Squibb, Celgene, UCB Pharma, AbbVie, Astra Zeneca, Serono, Genentech, Tillotts Pharma AG, Unity Pharmaceuticals, Albireo Pharma, Given Imaging Inc., Salix Pharmaceuticals, Novo Nordisk, GSK, Actogenix, Prometheus Therapeutics and Diagnostics, Athersys, Axcan, Gilead, Pfizer, Shire, Wyeth, Zealand Pharma, Zyngenia, GiCare Pharma Inc., and Sigmoid Pharma; and speaker’s fees from UCB, AbbVie, and J&J/Janssen. Vipul Jairath has received consulting fees from AbbVie, Sandoz, Takeda, Janssen, Robarts Clinical Trials; speaker’s fees from Takeda, Janssen, Shire, Ferring.
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