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Healthcare Providers Underestimate Patients’ Glucocorticoid Use in Crohn’s Disease

Abstract

Background

One of the therapy goals for Crohn’s disease (CD) is glucocorticoid-free remission. Studies have shown care setting-specific variations in inflammatory bowel disease (IBD) management.

Aims

The principal objective of this study was to assess concordance between patient-reported and physician-reported outcomes in two different care settings (IBD centers and community practices).

Methods

Data of overall and long-term (≥ 3 months) glucocorticoid, immunosuppressant, and biologics use in participants ≥ 18 years old with a confirmed diagnosis of CD were collected. HCPs were grouped by IBD centers and community practices. Quality of life (using EuroQol 5D [EQ-5D]) and work/activity days lost were assessed. Agreement between patients’ and HCPs’ responses to survey questions was tested using kappa statistics.

Results

Data from 812 patients were examined. Significantly more patients versus HCPs reported oral glucocorticoid use (25.9% vs. 20.8%, κ = 0.735, P < 0.0001). Long-term use of oral glucocorticoids was similar for patients versus HCPs (67.7% vs. 63.8%, κ = 0.598, P = 0.53). Immunosuppressant use was 52.4% vs. 51.1% (κ = 0.784) and biologics use was 49.5% vs. 47.0% (κ = 0.909) for patients vs. HCPs. Patients and HCPs reported greater rates of symptom improvement with vs without biologic therapy (patients: 33.3% vs 16.8%; HCPs: 29.3% vs 13.5%, both P < 0.001). Patients with versus without routine follow-up were less likely to be treated with long-term glucocorticoid monotherapy (10.3% vs. 20.7%, P < 0.01) and had fewer lost work/activity days (5 vs. 8 days, P < 0.05).

Conclusions

Patients reported more oral glucocorticoid use than physicians thought. Routine follow-up and higher rates of biologic use are associated with improvement in disease symptoms and general health among patients with CD.

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Acknowledgments

Writing support was provided by Joann Hettasch, Ph.D., of Fishawack Facilitate Ltd, Conshohocken, PA, and was funded by AbbVie, Inc., North Chicago, IL.

Funding

This study was funded in full by AbbVie, North Chicago, Illinois, which is represented by R. Thakkar, S. Wang, M. Skup, and J. Chao. AbbVie was involved in developing the study concept and participated in the analysis and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

Authors

Contributions

S. Ghosh planned and conducted the study, collected data, reviewed the manuscript, made substantial content suggestions, and approved the final draft. B. Bressler conducted the study, collected data, interpreted data, reviewed the manuscript, made substantial content suggestions, and approved the final draft. J. Petkau conducted the study, collected data, interpreted data, reviewed the manuscript, made substantial content suggestions, and approved the final draft. R. B. Thakkar interpreted data, reviewed the manuscript, made substantial content suggestions, and approved the final draft. M. Skup conducted the data analyses, interpreted data, reviewed the manuscript, made substantial content suggestions, and approved the final draft. S. Wang conducted the data analyses, interpreted data, reviewed the manuscript, made substantial content suggestions, and approved the final draft. J. Chao conducted the data analyses, interpreted data, reviewed the manuscript, made substantial content suggestions, and approved the final draft. R. Panaccione conducted the study, collected data, interpreted data, reviewed the manuscript, made substantial content suggestions, and approved the final draft. S. Schreiber conducted the study, collected data, interpreted data, reviewed the manuscript, made substantial content suggestions, and approved the final draft.

Corresponding author

Correspondence to Subrata Ghosh.

Ethics declarations

Conflict of interest

S. Ghosh has served on ad hoc advisory boards of AbbVie, Merck, Shire, Pfizer, Receptos, Novo-Nordisk, Bristol-Myers Squibb, and Janssen. He has received honoraria for lecturing in educational events from AbbVie, Merck, Janssen, Takeda, and Shire and has received research support from AbbVie and Merck. B. Bressler is a consultant for AbbVie, Actavis, Jansen, Shire, Genentech, Takeda, Pendopharm, Celltrion; served on the Speaker’s Bureau for AbbVie, Jansen, Takeda, Shire, Ferring, Actavis; received research/educational support from AbbVie, Jansen, Millenium, Bristol-Myers Squibb, Amgen, GSK, Genentech, Celgene, AstraZeneca, RedHill Biopharma, Alvine, and BI, and has stock options from Qu Biologics. J Petkau has nothing to disclose. RB Thakkar and M Skup are employees of AbbVie and may hold stock. J Chao and S Wang were employees of AbbVie at the time of research and may own AbbVie stock. R Panaccione served as a consultant for AbbVie, Amgen, Aptalis, AstraZeneca, Baxter, Eisai, Ferring, Jansen, Merck, Schering-Plough, Shire, Centocor, Elan, Glaxo-Smith Kline, UCB, Pfizer, Bristol-Myers Squibb, Warner Chilcott; served on the Speaker’s Bureau for AbbVie, AstraZeneca, Jansen, Schering-Plough, Shire, Centocor, Elan, Prometheus, and Warner Chilcott; served on advisory boards for AbbVie, Amgen, Aptalis, AstraZeneca, Baxter, Eisai, Ferring, Jansen, Merck, Schering-Plough, Shire, Centocor, Elan, Glaxo-Smith Kline, UCB, Pfizer, Bristol-Myers Squibb, Warner Chilcott; and received research/educational support from AbbVie, Ferring, Jansen, Schering-Plough, Centocor, Millenium, Elan, Proctor and Gamble, and Bristol-Myers Squibb. S Schreiber served as study investigator and consultant for AbbVie and has participated in continuing medical education events supported by unrestricted educational grants from AbbVie. He has also served as a consultant and as a lecturer for Centocor/MSD, Schering-Plough, UCB, and Shire.

Ethical statement

The study protocol was approved by independent Medical Research Ethics Committees in agreement with local legal requirements in Canada and Germany. All patients provided written informed consent before participating in the study. Consenting patients were also asked to sign and date a form indicating that they were willing to have their HCP supply additional information about their condition and their current and previous CD treatment. To protect disclosure of patient identities, a unique identification number was assigned to each patient before collection of data; this identification number was used on both the patient and HCP questionnaires. No patient identifiable information was included in any of the information collected.

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Ghosh, S., Bressler, B., Petkau, J. et al. Healthcare Providers Underestimate Patients’ Glucocorticoid Use in Crohn’s Disease. Dig Dis Sci 64, 1142–1149 (2019). https://doi.org/10.1007/s10620-018-5419-3

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  • DOI: https://doi.org/10.1007/s10620-018-5419-3

Keywords

  • Crohn’s disease
  • Glucocorticoids
  • Patient-reported outcomes
  • Physician-reported outcomes
  • Quality of life