How do patients with inflammatory bowel disease want their biological therapy administered?

Abstract

BackgroundInfliximab is usually administered by two monthly intravenous (iv) infusions, therefore requiring visits to hospital. Adalimumab is administered by self subcutaneous (sc) injections every other week. Both of these anti-TNF drugs appear to be equally efficacious in the treatment of Crohn's Disease and therefore the decision regarding which drug to choose will depend to some extent on patient choice, which may be based on the mode of administration.The aims of this study were to compare preferences in Inflammatory Bowel Disease (IBD) patients for two currently available anti-TNF agents and the reasons for their choices.MethodsAn anonymous questionnaire was distributed to IBD patients who had attended the Gastroenterology service (Ulster Hospital, Dundonald, Belfast, N. Ireland. UK) between January 2007 and December 2007. The patients were asked in a hypothetical situation if the following administering methods of anti-TNF drugs (intravenous or subcutaneous) were available, which drug route of administration would they choose.ResultsOne hundred and twenty-five patients fulfilled the inclusion criteria and were issued questionnaires, of these 78 questionnaires were returned (62 percent response). The mean age of respondent was 44 years. Of the total number of respondents, 33 patients (42 percent) preferred infliximab and 19 patients (24 percent) preferred adalimumab (p = 0.07). Twenty-six patients (33 percent) did not indicate a preference for either biological therapy and were not included in the final analysis. The commonest reason cited for those who chose infliximab (iv) was: "I do not like the idea of self-injecting," (67 percent). For those patients who preferred adalimumab (sc) the commonest reason cited was: "I prefer the convenience of injecting at home," (79 percent). Of those patients who had previously been treated with an anti-TNF therapy (n = 10, all infliximab) six patients stated that they would prefer infliximab if given the choice in the future (p = 0.75).ConclusionsThere was a trend towards patient preference for infliximab (iv) treatment as opposed to adalimumab (sc) in patients with IBD. This difference may be due to the frequency of administration, mode of administration or differing 'times in the market-place', as infliximab had been approved for a longer period of time in Crohn's disease. Further studies are required in IBD patients to investigate whether patient choice will affect compliance, patient satisfaction and efficacy of treatment with anti-TNF therapies.

Intravenous versus Subcutaneous Drug Administration. Which Do Patients Prefer? A Systematic Review

“…Although there are other good quality studies that examine patients' preferences [18][19][20][21][22][23][24], none are RCTs. For example, one study measured preferences of IBD patients for two anti-TNF agents in terms of their mode of administration by using hypothetical scenarios [18]. However, until patients actually have the drugs administered and experience the different modes of delivery, the route they favour may differ.…”

“…There are in fact few studies where patients' preferences or acceptance for IV and SC drug administration are primary outcomes [18][19][20][21][22][23][24]. A good example is the report by Barbee et al (2013) [19] in which patients with MM who received at least one dose each of IV and SC bortezomib were asked via a questionnaire about their preference for route of drug delivery; 68% preferred SC whilst 25% favoured IV.…”

Infliximab therapy increases the frequency of circulating CD16+ monocytes and modifies macrophage cytokine response to bacterial infection

“…Infliximab is a chimeric monoclonal immunoglobulin (Ig)G1 antibody (75% human, 25% mouse protein), and is highly effective in neutralizing TNF biological activity [4,5]. The efficacy of infliximab is well established in CD patients with severe, steroid-refractory or fistulizing disease [6,7], as well as in patients with moderate-to-severe UC [8]. Although infliximab has been proved to be highly effective in the clinical management of IBD, its mechanism of action is not completely understood.…”

Adherence to adalimumab therapy in Crohnʼs disease: A French multicenter experience

“…17 A recent survey has shown that 42% of respondents preferred infliximab over adalimumab, which was preferred by 24% of patients. 18 Interestingly, the most commonly reason cited by the patients who chose infliximab was that they did not like the idea of self-injecting, even though the difference did not reach statistical significance. 18 Importantly, nonadherence rates for maintenance therapy in IBD were correlated with increased healthcare costs.…”

“…18 Interestingly, the most commonly reason cited by the patients who chose infliximab was that they did not like the idea of self-injecting, even though the difference did not reach statistical significance. 18 Importantly, nonadherence rates for maintenance therapy in IBD were correlated with increased healthcare costs. 19,20 Poor adherence is also associated with a higher relapse risk in ulcerative colitis (UC).…”