2018
DOI: 10.1007/s10620-018-5181-6
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Physicians’ Perspectives on Cost, Safety, and Perceived Efficacy Determine Aminosalicylate Use in Crohn’s Disease

Abstract: 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.

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Cited by 13 publications
(11 citation statements)
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“…Therefore, there might also be a perception of efficacy of 5-ASA in CD amongst physicians. 24 For example, in the study from the Swiss IBD cohort, physicians judged 5-ASA to have been clinically successful in nearly half of CD patients. 20 In a survey of German gastroenterologists, one-third of respondents would use 5-ASA as maintenance therapy in colonic and ileo-colonic CD 25 and in a survey of Australian gastroenterologists 96% of respondents answered that they had used 5-ASA in CD patients.…”
Section: Discussionmentioning
confidence: 99%
“…Therefore, there might also be a perception of efficacy of 5-ASA in CD amongst physicians. 24 For example, in the study from the Swiss IBD cohort, physicians judged 5-ASA to have been clinically successful in nearly half of CD patients. 20 In a survey of German gastroenterologists, one-third of respondents would use 5-ASA as maintenance therapy in colonic and ileo-colonic CD 25 and in a survey of Australian gastroenterologists 96% of respondents answered that they had used 5-ASA in CD patients.…”
Section: Discussionmentioning
confidence: 99%
“…Furthermore, prescribing potentially ineffective therapies as first‐line treatment is likely to delay therapies which may be more effective if prescribed sooner in the disease course. The reasons for this large disparity between evidence and practice are likely to be multifactorial, including 5‐ASA being inexpensive, lack of belief in the existing evidence from RCTs, limited treatment choices in patients with milder disease as well as clinician and patient preference to begin with treatment perceived as less aggressive …”
Section: Discussionmentioning
confidence: 99%
“…The reasons for this large disparity between evidence and practice are likely to be multifactorial, including 5-ASA being inexpensive, lack of belief in the existing evidence from RCTs, limited treatment choices in patients with milder disease as well as clinician and patient preference to begin with treatment perceived as less aggressive. 25 In addition to the lack of proven effectiveness of 5-ASA in CD, treatment guidelines have addressed the potential for the rare and idiosyncratic 5-ASA-induced renal toxicity with suggestions for monitoring renal function in those at greater risk of impairment. 12,26 While the exact mechanism of 5-ASA-related nephrotoxicity is still unclear, clinical reports include renal failure, interstitial nephritis and glomerulosclerosis as part of the pathophysiology.…”
Section: Discussionmentioning
confidence: 99%
“…There are no randomised data to inform whether aminosalicylates should be continued or stopped when patients are escalated to immunosuppressants, biologics, or oral small molecules. Although aminosalicylates are often perceived to be a relatively inexpensive and innocuous class of therapy, their cumulative use may present a substantial economic burden to patients and payers, and increase the risk of rare but potentially serious adverse events (AEs) such as nephrotoxicity . Results from the Swiss Inflammatory Bowel Disease Cohort Study indicate that there is a positive correlation between the number of concomitant therapies and risk of drug‐related AEs in inflammatory bowel disease (IBD) .…”
Section: Introductionmentioning
confidence: 99%