An online decision aid may help patients and physicians select biologic agents to treat inflammatory bowel disease (IBD).
Researchers at Cedars-Sinai Medical Center in Los Angeles used conjoint analysis to examine decision making about biologic agents for IBD among patients with ulcerative colitis and Crohn's disease, asking them to rate the relative importance of different biologic attributes in four categories: mechanism of action, mode of administration, efficacy, and side effect profile. Generic and brand names of biologic medications were not included in the survey. Individual patient preferences were determined by software that calculated part-worth utilities for each of the attributes. In regression analyses, the researchers examined whether patients' decisions could be predicted by demographic characteristics or by disease characteristics. Educational grants from Takeda Pharmaceuticals were used to fund development of a self-assessment website for patients based on the study results. The study was published online Dec. 5 by the American Journal of Gastroenterology.
Patients with IBD were recruited from February 2016 to September 2016. A total of 640 patients completed the survey, 304 who had ulcerative colitis and 336 who had Crohn's disease. Overall, 41.3% of respondents said treatment efficacy was the most important attribute for a biologic, and 53.9% preferred subcutaneous administration at home over IV administration in a clinic. In most cases, demographic and disease characteristics did not seem to predict patients' treatment preferences. However, patients with Crohn's disease were more likely than those with ulcerative colitis to report that side effect profile was their most important consideration (odds ratio, 1.63; 95% CI, 1.16 to 2.30), and patients with ulcerative colitis were more likely to report that therapeutic efficacy was most important (odds ratio, 1.41; 95% CI, 1.01 to 2.00). Non-Hispanic black patients were more likely to rank mode of administration as their most important consideration than were non-Hispanic white patients (odds ratio, 2.55; 95% CI, 1.05 to 6.20).
The authors noted that the way patients responded to hypothetical treatments may differ from their responses in a real-world scenario, that the survey response rate was relatively low at 33.1%, and that the survey may have been challenging for patients with lower numeracy skills, among other limitations. However, they concluded that based on their results, patients with ulcerative colitis and Crohn's disease vary greatly in decision making about biologic therapy.
“When considering each respondent's individual ‘preferences report,’ we found that 98% had a completely unique decision-making profile,” the researchers wrote. “These results emphasize that biologic decision-making is highly individualized; providers cannot rely on demographic or clinical variables to neatly categorize patient preferences or attempt to predict which biologic will optimal[ly] map with a patient's personal values.” The tool developed in their study is available free of charge online.