Evaluating Treatment Perception and Productivity Impairment in Inflammatory Bowel Diseases Patients on Anti-TNF Therapy
Background:
Anti-tumor necrosis factor (anti-TNF) agents have been a mainstay therapy option for patients with inflammatory bowel diseases (IBD). However, they may present with varying outcomes, ranging from great efficacy to loss of response that may induce shifting symptomatology. This study aims to assess if such variability may affect perception of treatment and illness management, and trigger alterations in patient productivity within the workplace and academia.
Methods:
Patients with IBD attending a tertiary care clinic were interviewed concerning education, previous/current employment, and medical history. Anti-TNF was deemed responsive when disease symptomatology mitigated after initiating therapy; loss of response to treatment described as previously effectual but subsequently inadequate and requiring a change in therapy; and no response to therapy described as anti-TNF added to treatment regimen but did not induce desired effect. Productivity was defined by the number of absences or early leaves from school or work due to disease exacerbation. Perceptions regarding the type of treatment and attitudes when handling the disease were evaluated. Bivariate analyses were executed. This study is approved by the UPR-MSC IRB.
Results:
A total of 157 patients on anti-TNF therapy at time of interview were included (132CD/25UC, 82F/75M, mean age: 32.0±10.9). Regarding therapy effectiveness, 51.6% responded to treatment, 24.2% gradually lost response to the treatment, 19.1% did not respond to the therapy, and 5.1% developed an adverse effect to the treatment. In terms of patient satisfaction with their medical treatment, 67.5% were satisfied to very satisfied, 19.7% neutral, and 12.7% unsatisfied to very unsatisfied. There was no statistical significance concerning medical treatment satisfaction between patients who responded to anti-TNF treatment and those who gradually lost response to treatment or did not have a response (p=0.07). Regarding patient attitudes when handling their IBD, 73.9% managed their condition with a positive to very positive attitude, 24.2% with a neutral one, and 1.9% with a negative to very negative attitude. No statistical significance was found concerning disease handling attitudes between patients who responded to anti-TNF therapy and those who gradually lost response to treatment or did not have a response (p=0.06). Out of the 157 patients, 69.4% were currently employed, of which 79.8% had to leave work early or take time off due to IBD symptomatology. Patients who lost response or had no response to therapy were at greater odds for absences or early leave from work due to disease symptomatology than those who had response to anti-TNF (p=0.01). In terms of education, 33.8% were currently studying, of which 81.1% specified that they had to leave school early or absent themselves from class due to exacerbation of their condition. No statistical significance was found concerning absences or early leave from academic setting between patients who had response to anti-TNF therapy and those who lost response or had no response to treatment (p=0.28).
Conclusions:
Most patients on anti-TNF therapy stated satisfaction regarding current treatment. Nonetheless, patients were negatively impacted in the professional and educational environments. Additional studies concerning variable anti-TNF effectiveness may provide a deeper insight into loss of productivity in these settings.
