P1126 Patterns of conventional therapy use and drivers of initiation for advanced therapy in Inflammatory Bowel Disease: A European situational analysis

Background

Data suggest limited use of advanced therapies (AT) in inflammatory bowel disease (IBD) despite the accumulating data for the benefits of early, broader AT use.1-3 We evaluated barriers to AT use in IBD using a multimodal approach.

Methods

Market research was conducted June-November 2023. Quantitative survey on prescribing trends amongst gastroenterologists (GEs) prescribing ATs was conducted to capture AT initiation drivers in Germany, Italy, UK and US; questions for this survey were identified in qualitative interviews. GEs cycling an average of 0-1 and ≥2 conventional therapies (CTs) before initiating AT were classified as low and high cyclers, respectively. The COM-B (Capability, Opportunity, Motivation and Behaviour) model was used for behavioural analysis.4

Results

Qualitative analysis covered responses from 62 participants (28 patients [pts], 24 GEs, 7 nurses, 3 pt organisation representatives), and quantitative analysis – from 142 GEs (Germany, 30; Italy, 30; UK, 30; US, 52) currently prescribing ATs, with 559 pt report forms (ulcerative colitis [UC], 280; Crohn’s disease [CD], 279) collected. CT cycling was more prevalent in UC vs CD; AT treatment was less likely in pts with UC vs CD (Figure). Differences among GEs by geography were only partially explained by cost containment in highly regulated markets (eg, Italy, UK). High cycling variations were linked to behavioural and belief-driven factors as illustrated by the notable use (7-20%) of 5-aminosalicylates in CD despite the lack of clinical guideline support. In behavioural analysis, AT initiation barriers included a lack of awareness of AT value and prescribing approach of exhausting all CT options before initiating AT. Low vs high cyclers placed higher importance on patient preference (UC, +16%; CD, +19%) and peer recommendations (UC, +13%; CD, +20%). In UC, the belief of exhausting all CT options before initiating AT was more important for high vs low cyclers (+9%). Qualitative research showed that the lack of clear guidelines disproportionately impacted high cyclers as they had reduced academic interest and limited capacity as contributors. Physician-relevant AT initiation drivers were the perceived CT risks and the growing recognition of the AT clinical value and long-term impact on the quality of life. Pt-relevant drivers included improved AT awareness and the ability and confidence for pts to self-advocate.

Conclusion

Cost containment and guideline variations could partially explain the observed geographic variations in AT use. Within any given country, clinical beliefs play a determining role. In Europe, a tangible increase in AT vs CT share could be achieved by encouraging GEs to initiate AT in pts with poor prognostic factors as per guideline suggestions.

References

1. Noor NM, Lee JC, Bond S, et al. Lancet Gastroenterol Hepatol 2024;9(5):415-427.

2. Gordon H, Minozzi S, Kopylov U, et al. J Crohns Colitis 2024;18(10):1531-1555.

3. Kumar A, Yassin N, Marley A, et al. Therap Adv Gastroenterol 2023;16:17562848231218615.

4. Michie S, van Stralen MM, West R. Implement Sci 2011;6:42.