Striking differences in patients’ and physicians’ treatment goals and disease management expectations
Survey reveals important differences in how patients and physicians define disease remission and the importance of remission as a clinical goal.
The IBD Global Assessment of Patient and Physician Unmet Needs Survey (IBD GAPPS) captured insights and perspectives from more than 2,000 patients and 600 physicians, exploring the physician-patient relationship, how patients and physicians define remission, their treatment expectations and levels of satisfaction with current therapies, as well as the impact of ulcerative colitis (UC) and Crohn’s disease (CD) on disease-related quality of life. Results from the survey were presented at the 15th Congress of the European Crohn’s and Colitis Organisation (ECCO) in Vienna, Austria.
“As gastroenterologists and patients work together to best manage IBD, we need to shift the conversation from focusing on short-term goals like symptom relief to an emphasis on achieving long-term disease control so that patients can lead productive lives,” said David T. Rubin, M.D., Section Chief of Gastroenterology, Hepatology and Nutrition, Co-Director, Digestive Diseases Center, University of Chicago Medicine and Chair of the IBD GAPPS Steering Committee. “IBD GAPPS provides real-world insight into fundamental gaps in understanding, communication and expectations between patients and physicians that are important to consider in our approach to setting treatment goals and improving long-term disease outcomes.”
Important Differences Exist Between How Patients and Physicians Define Remission
The survey revealed important and meaningful differences in how patients and physicians define IBD remission. The majority of physicians defined remission based on clinical test results (64 percent of physicians for CD, 70 percent for UC) whereas patients (45 percent) most commonly defined remission as the resolution of IBD symptoms. Additionally, while most physicians and patients acknowledge discussing remission (93 percent of physicians, 78 percent of patients), their distinct definitions of remission highlight a need for greater alignment.
High Prevalence of Corticosteroid Use Reflects Significant Unmet Need for Improved Therapies
Results from IBD GAPPS showed that more than one-third of IBD patients (35 percent of CD patients, 39 percent of UC patients) used corticosteroids for four or more months over the past year to control their disease. Physicians believe more than 40 percent of IBD patients will require four or more months of corticosteroid use per year to maintain disease control. Yet despite high patient concern over any corticosteroid use, and most patients wanting to stop corticosteroid treatment as soon as their disease is under control, only approximately 50 percent of physicians expressed concern over four or more months of corticosteroid use per year.
Physicians’ Satisfaction with Remission Rates & Sustained Treatment Response May Impact Treatment Outcomes
Based on the survey findings, physicians’ satisfaction with relatively low IBD remission and durability rates may suggest an acceptance of sub-optimal outcomes in chronic disease control. Physicians indicated up to 63 percent of IBD patients will not obtain remission with current therapies; however, many physicians are highly satisfied with these results (25 percent of physicians for CD, 36 percent for UC). Additionally, physicians (up to 58 percent for UC and up to 63 percent for CD) reported that they see an average sustained response of at least one or at least two years with current therapies, with most physicians moderately to highly satisfied with these results.
Despite these low physician expectations, most patients believe remission is a feasible treatment goal, and approximately one-third of patients expect their treatment to provide five or more years of disease control. These expectations exist despite many patients (61 percent) reporting only partial IBD control with current therapies.