P482 Patient and physician perspectives on the management of inflammatory bowel disease: Disease remission and durability of treatment
Authors: Afzali A , Armuzzi A , Bouhnik Y , Bressler B , Hart A , Rubin D , Sans M , Siegmund B , Sninsky C 
Published: January 2020

Abstract

Background
Achieving disease remission and selecting durable maintenance therapy are essential treatment goals in IBD. To gain insight into real-world management of IBD from both the patient (pt) and physician perspective, we conducted international online surveys. Here we report results related to patients’ and physicians’ beliefs, experience, and expectations regarding IBD remission and durability of IBD treatments.

Methods
Surveys were fielded in Canada, France, Germany, Italy, Spain, UK, and the USA. The mixed-recruitment methodology was used; patients were recruited by physicians, patient advocacy groups, and panels; physicians were recruited by recruitment agencies and panels. Patients aged ≥18 years with a diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) who had received treatment for IBD and had not undergone surgery for UC were eligible. Physicians were eligible to participate if they were gastroenterologists who had treated ≥12 patients with CD and ≥12 patients with UC in the last month, were responsible for treatment decisions for their IBD patients, and for whom ≤70% of their IBD patients had a mild disease (based on prespecified clinical criteria). A 1:1 ratio of CD:UC patients was targeted for the patient survey.

Results
Surveys were completed by 2398 IBD patients (1368 CD, 1030 UC) and 654 physicians. Mean age was 43 years and 45 years for patients with CD and UC, respectively; 60% and 55% were female. Physicians had a mean monthly caseload of 42.9 CD patients and 43.3 UC patients; most physicians were in a university/teaching hospital (41%), private practice (31%), or regional/community hospital (20%). Most patients (78%) reported discussing remission with their physician, whereas nearly all physicians (93%) reported they typically discussed remission. Remission was most frequently defined by resolution of symptoms for patients (45%) and by test results for physicians (64% for CD, 70% for UC). Most patients felt that their IBD was only partially controlled (61%) with their current treatment; &gt;80% expected to be on treatment in 5 y, and only 33% of patients were satisfied with this expectation. Although ~30% of patients expected their current treatment to control their IBD for ≥5 y, only 7% of physicians had this expectation; most physicians estimated a response duration of just 1–2 y with current treatments. Most physicians reported moderate satisfaction with response duration (60% for CD patients, 71% for UC) and remission rate (72% for CD, 81% for UC) with current treatments.

Conclusion
This international survey demonstrated both patients and physicians discuss remission but more patients expect sustained control of their disease. This lack of concordance in expectations may hinder communication and treatment optimisation. Better alignment between patients and physicians on treatment goals and measures of success may improve IBD management.