Barriers to anti‐TNFalpha prescription among Italian physicians managing inflammatory bowel disease

Abstract

Summary Background Italian physicians managing IBD patients seem to prescribe anti‐TNFalpha agents less frequently than physicians in other countries. Aims To investigate reasons and situations that limit the use of these medications. Methods A questionnaire was distributed to 600 physicians attending IG‐IBD events. Results Two hundred eighty physicians (46.7%) completed the questionnaire. Most physicians (76.2%) prescribed anti‐TNFalpha every time one was needed, however, 12.6% were limited by budget, 8.1% lacked confidence, 2.2% lacked permission and 0.9% chose not to prescribe them. The limitations in using anti‐TNFalpha were: fear of side effects (39.1%), costs (38.2%), administrative/bureaucratic limitations (8.0%) and lack of staff (6.2%). The main feared side effects include: opportunistic infection (45.7%), neoplasms (25.4%), allergic reactions (12.5%), reactivation of tuberculosis (7.3%) and onset of autoimmune disease (7.3%). Physicians younger than 45 years of age and with less than 15 years of clinical experience were more likely to prescribe anti‐TNFalpha than older physicians (70.8% vs 57.1%; P = 0.022) than more experienced physicians (71.2% vs 58.9%; P = 0.033). Conclusions The apparent underuse of anti‐TNFalpha in Italy can be attributed mainly to physicians’ fears of side effects, concerns about costs and scarce familiarity with these drugs. Addressing these barriers may lead to an improvement in the quality of assistance to IBD patients.

Who are the patients with Crohn’s disease unsuitable to receive an anti-TNFα therapy? Results from a survey of Italian physicians and literature review

“…This indicates how the potential number of patients that could benefit from a biologic drug is potentially higher and that the penetrance of biological drugs use in Crohn's disease is still relatively low in Italy as compared to other European countries. This is at least in part explained by poor familiarity with biologics, by concerns about their potential adverse effects by the clinicians, as well as by the willingness to pay for biologic therapies [19].…”

Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period

“…[9][10][11][12] Considerable variation exists between healthcare providers in the treatment of IBD with biologics. [13][14][15][16][17][18] Treatment variation consists, among other things, of differences in provided care and follow-up, such as type of medication prescribed, dosing frequency and interpretation of therapeutic drug monitoring. Treatment variation can lead to differences in outcomes, such as the proportion of patients in remission, side effects and treatment costs.…”

Improving IBD care: influences on physician and patient behaviour

“…This issue of GastroHep features three papers on inflammatory bowel diseases (IBD) . The first paper by Cristina Bezzio et al looks into the barriers to anti‐TNFalpha prescription among Italian physicians managing inflammatory bowel disease .…”

“…This issue of GastroHep features three papers on inflammatory bowel diseases (IBD) . The first paper by Cristina Bezzio et al looks into the barriers to anti‐TNFalpha prescription among Italian physicians managing inflammatory bowel disease . Despite considerable concordance of best practice recommendations from national and international physician bodies like ECCO (European Crohn's and Colitis Organisation) there remains a great disparity in biologic prescription rates in European nations.…”