P070 Patient Perspective and Timing of First-Line Advanced Systemic Treatments in IBD: Results From a National Chart Audit
Authors: Price Lynn , Schmitt Lauren 
Published: December 2019

BACKGROUND:
There is increased evidence that early and aggressive use of advanced systemic agents for patients with inflammatory bowel disease (IBD) produces better patient outcomes, particularly for patients afflicted with Crohn’s disease. However, convincing IBD patients to initiate advanced treatment early on can sometimes be difficult. This research sought to better understand the process of beginning first line biologic or JAK treatment and uncover insights into the timing of initiation via assessment of the level of patient engagement, initiation discussion timelines, and general patient attitudes regarding initiation of first line systemic treatment with either a biologic or JAK inhibitor.

METHODS:
An independent market analytics firm collaborated with US gastroenterologists (n = 219) to conduct a retrospective chart review of patients with either ulcerative colitis (UC) or Crohn’s disease (CD) (n = 1,006), who had been initiated on their first biologic or JAK in the twelve weeks prior to data collection. Gastroenterologists were required to submit at least three and up to seven IBD patient charts. Data were collected in May and June of 2019 and included clinical and non-clinical patient demographics, first-line treatment regimens, reasons for first line brand choice, as well as metrics regarding the treating physician’s perceptions.

RESULTS:
Collaborating gastroenterologists estimate that 22% of their UC and 24% of their CD patients on first line biologic or JAK therapy should have initiated treatment earlier in their disease. Patients are rarely the individual starting treatment conversations regarding beginning advanced systemic therapy, as physicians report they themselves are the one to initiate this discussion 88% of the time. Among audited IBD patients, treating gastroenterologists report that they had discussed advanced systemic treatment with their patients for an average of 4.7 months prior to beginning therapy with a biologic or tofacitinib. Furthermore, while most patients (63%) had positive emotions about beginning biologic or JAK therapy (excitement or relief), 15% were reportedly resigned to the fact that it was necessary and an additional 22% were anxious about starting treatment. Patients started on tofacitinib first-line were significantly more likely to feel “excited” about beginning treatment than patients initiated on a first line biologic.

CONCLUSION(S):
With increased evidence of the success of early and aggressive use of biologics or JAKs for the treatment of IBD, it is important for gastroenterologists to begin having discussions with their patients at the first sign of necessity. On average, patients are not initiated on their first biologic or JAK treatment for over four months after physicians first propose the treatment options to their patients. Furthermore, physicians assess that over one in five of their first line biologic or JAK treated patients should have begun treatment earlier in their disease and a similar percent are reportedly “anxious” about starting advanced systemic therapy.