IBD Patients Balance Symptom Improvement With Treatment Risks

Given IBD patients’ varying treatment preferences, clinicians should consider benefit-risk tradeoffs patients face.

Patients with inflammatory bowel disease (IBD) are willing to make trade-offs among multiple potential treatment benefits and risks, according to study results published in the Journal of Crohn’s and Colitis.

The P-POWER IBD study used a discrete choice experiment (DCE) and thresholding exercise (TE) to quantify the effect of different treatment attributes on patient preferences.

A cross-sectional online survey was conducted in adult patients with Crohn disease (CD) and ulcerative colitis (UC). Study participants were aged 18 years and older and were currently receiving treatment for IBD.

The DCE included 6 treatment attributes: administration, abdominal pain, bowel urgency, fatigue, risk for mild or moderate side effects, and risk for serious infections. Participants were asked to complete a series of choices between 2 hypothetical treatment alternatives. A TE was performed to elicit the participants’ average maximum acceptable risk (MAR) for cancer and maximum acceptable number of weeks on steroids per year. The DCE and TE were then integrated into a comprehensive questionnaire.

A total of 400 patients (CD, 54%; UC, 46%; women, 38.0%; mean age, 41 [range, 18-78] years) were included.

The participants generally valued pain reduction, not having to rush to the toilet, not having severe levels of fatigue, and having lower risk for adverse events. Patients also significantly preferred injections vs infusions and preferred daily oral pills at home instead of injections.

The differences in the relative importance that patients placed on treatment attributes indicate that treatment selection should consider multiple features carefully…

Avoiding abdominal pain was most important to patients (relative attribute importance [RAI], 33.4%; 95% CI, 29.2%-37.5%) followed by the risk for mild or moderate side effects (RAI, 26.8%; 95% CI, 21.8%-31.7%), risk for serious infections (RAI, 15.7%; 95% CI, 10.1%-21.3%), treatment administration (RAI, 9.7%; 95% CI, 6.8%-12.6%), fatigue (RAI, 8.8%; 95% CI, 6.9%-10.7%), and bowel urgency (RAI, 5.7%; 95% CI, 3.4%-7.9%). All treatment benefits combined (RAI, 50.9%) were about as important as all risks together (RAI, 49.1%).

Patients with CD had greater importance on abdominal pain (RAI, 36.4% vs 30.5%, respectively; P =.032) compared with those who had UC. Participants with UC had greater importance on bowel urgency vs those with CD (RAI, 7.4% vs 3.7%, respectively; P = .039).

In subgroup analyses, women had a lower relative importance on administration (P <.001) and more importance on abdominal pain (P <.001) vs men. Participants aged 35 years and younger placed more importance on administration and less importance on abdominal pain vs older patients.

The overall average MAR of cancer was 4.8% and differed significantly between the disease types (UC, 4.0% vs CD, 5.6%; P =.023).

The participants who were diagnosed over 5 years ago had more importance on administration compared with those who were diagnosed less than 2 years ago or 2 to 5 years ago (both P <.001), more importance on bowel urgency vs those diagnosed less than 2 years ago (P =.005), and less importance on abdominal pain vs those diagnosed more recently (P <.001).

Study limitations include using patient-reported data, which may have led to variability in participants’ interpretations of some questions. In addition, selection bias is a potential limitation, and recruitment was affected by the COVID-19 pandemic.

“The differences in the relative importance that patients placed on treatment attributes indicate that treatment selection should consider multiple features carefully and, due to the considerable preference heterogeneity observed, treatment selection may benefit from highly individualized approaches,” the researchers concluded.

Disclosure: This work was supported by AbbVie. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Louis E, Siegel CA, James B, Heidenreich S, Krucien N, Ghosh S. Patients with Inflammatory bowel disease have heterogeneous treatment preferences that are largely determined by the avoidance of abdominal pain and side effects [P-POWER IBD study]. J Crohns Colitis. Published online September 20, 2022. doi:10.1093/ecco-jcc/jjac130