Patients perceive biologic medications to be among the riskiest— but beneficial — treatments for inflammatory bowel disease (IBD), according to research published in Inflammatory Bowel Disease.

Researchers evaluated patient perceptions of the risks associated with various IBD therapies in relation to other medical therapies and everyday life situations. They also sought to determine how personality traits might influence these perceptions.

A cross-sectional survey was given to consecutive patients at the Dartmouth-Hitchcock IBD Center between January and April 2017. All patients had a self-reported history of Crohn’s disease or ulcerative colitis. The survey was intended to obtain patient perceptions of risk in 15 categories, including IBD and non-IBD medications, invasive procedures, everyday life situations, and demographics, in addition to the Multidimensional Health Locus of Control (MHLC) Scale. The MHLC scale is an 18-item questionnaire measuring health-related control beliefs.


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The total study cohort was of 118 patients (60.2% with Crohn’s disease and 39.8% with ulcerative colitis; the mean age was 48.2±16.2 years; and 69.2% were women). One-third of all patients considered their symptoms to be “often” or “constantly” active on the Manitoba IBD index, with 47.1% reporting an IBD-related surgery and 52.3% reporting IBD-related hospitalization.

Of all IBD interventions, colonoscopy was considered to have the least risk and be the most beneficial. In terms of benefit and risk, steroids and biologics were both considered more beneficial and riskier than immunomodulators. Bowel resection was considered to be slightly more risky, but more beneficial than biologic treatment.

Biologics were also perceived to be the most dreadful of all IBD medications, but still less dreadful than bowel resection. A ranking of most- to least-dreadful medications included biologics, warfarin, steroids, immunomodulators, herbal supplements, mesalamines, antibiotics, and aspirin.

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The MHLC scale results found that the personality trait of control was associated with the perception that biologic medications for IBD were less scary (P =.008). These respondents also believed that mesalamine and immunomodulators were more beneficial treatments (P =.025 and P =.021, respectively). Those who believed that health outcomes are related to chance were more likely to believe that biologics have a higher associated risk (P =.016).

Limitations to the study include the use of a single-center and consecutive patients, limiting potential generalizability, the lack of qualitative focus groups, as well as the use of the MHLC. Future studies should include a “full and coherent” personality assessment.

Patient perceptions of biologic therapies for IBD “may be one of the barriers of having patients start our most effective therapies earlier in the course of their disease,” the researchers of the study concluded. They continued, “It is our job as providers…to help [patients] understand the favorable safety profile of biologics compared with immunomodulators and steroids.”

Reference

Kolani-Pace JL, Haron AM, Zisman-Ilani Y, Thompson KD, Siegel CA. Patients’ perceive biologics to be riskier and more dreadful than other IBD medications [published online July 13, 2019]. Inflamm Bowel Dis. doi: 10.1093/ibd/izz121