Pharmacological Efficacy and Treatment Satisfaction in Patients With Inflammatory Bowel Diseases in a Tertiary Care Setting

Background:
Patients with inflammatory bowel diseases (IBDs) require a precise pharmacological regimen to manage their condition effectively. The complexity in therapeutic approach arises from the necessity to balance goals of treatment, potential interactions, and unique patient needs. From a patient perspective, navigating a medication course may prove challenging. We aim to quantify the use of pharmacological treatments in a cohort with IBD and assess how these affect patients’ views on their disease.
Methods:
Patients with IBD visiting a specialized tertiary care clinic were surveyed about their education, past and present employment, and medical background. Medical records were examined for pharmacologic therapy and effectiveness. Medications included a 5-ASA (only for patients with UC), corticosteroids, any anti-TNF antibody, and ustekinumab and vedolizumab, analyzed combined as other biologics. A medication was considered effective when symptoms of the disease improved after treatment. Loss of response occurred when a medication that initially worked became ineffective over time, necessitating a change in therapy. No response to therapy was defined as a medication added to the treatment regimen that failed to produce the desired effect. The study also assessed patients’ views on treatment using a 5-point Likert scale: 1-2 being very unsatisfied-unsatisfied, 3 neutral, and 4-5 satisfied-very satisfied. Satisfaction was determined by how well various aspects of care, including medication regimen, aligned with their treatment expectations. Bivariate analyses were performed. The study is approved by the MSC IRB.
Results:
A total of 175 participants were surveyed (93F/82M, mean age 32.1±11.3, age range 18-79, 139CD/36UC). Medications used were 5-ASA in 86.1% of UC, anti-TNF in 84.6%, corticosteroids in 66.9%, and other biologics in 31.4%. Regarding treatment satisfaction within the cohort, 70.3% were satisfied-very satisfied with their medical treatment, 17.7% neutral, and 12.0% unsatisfied-very unsatisfied. Treatment effectivity and response varied within medication subgroups: 49.3% of patients responded to an anti-TNF, 69.2% to a corticosteroid, 38.7% to a 5-ASA, and 78.2% to other biologics. No response to therapy was 16.9% for anti-TNF, 16.2% for a corticosteroid, 35.4% for a 5-ASA, and 18.2% for other biologics. Loss of response was found in 28.4% of anti-TNF, 6.0% for a corticosteroid, 22.6% for a 5-ASA, and 1.8% of other biologics. No statistical significance was found between lack or loss of response and patient satisfaction or unsatisfaction for any of the drugs (anti-TNF p=0.23, corticosteroid p=0.51, 5-ASA p=0.82, other biologics p=0.19). There was no statistical significance when comparing those who did not respond or lost effectivity to medication and type of IBD (anti-TNF p=0.50, corticosteroid p=0.16, other biologics p=0.52).
Conclusions:
Most patients had a response to pharmacological treatment with biologics and to corticosteroids; 5-ASA was linked to an eventual loss of response in UC. Nonetheless, patients generally had a positive outlook regarding their medical treatment, irrespective of treatment effectiveness. Even in the context of a reduction in a drug’s efficacy, the comprehensive nature of their care, including how patients perceive treatment benefits and manage expectations, may contribute to a favorable view.