Introduction Personalised ANti-TNF Study (PANTS) is a prospective observational study of anti-TNF (aTNF) use in patients with Crohn’s disease. Patients receive either 8 weekly intravenous infliximab (IFX) or fortnightly adalimumab (ADA) subcutaneously. Whether patients are given a choice of aTNF agent by their clinician and what factors influence patient’s decision making, is unknown.
Methods A voluntary anonymous questionnaire was given to all adult patients upon enrolment into PANTS. 9 point Lickert scales and unprompted free-text entries were used to evaluate 3 domains: a) patient perceptions of aTNF choice, b) the methods used by healthcare teams to impart information regarding aTNF therapies, c) how drug-related factors influenced aTNF choice. Ethics approval ref:12/SW/0323.
Results The questionnaire response rate was 40% (534/1339). 57% (305/534) of patients were given a choice of aTNF.
A: Patient perception(n = 283). For 73% (206) the ability to choose aTNF treatment was important, and choosing between ADA and IFX was easy (195;69%). About a third (106;37%), however, were either ambivalent, or would rather their healthcare team made the choice for them. 15% (42) of patients felt their healthcare team tried to influence their choice.
B: Imparting information(n = 266). Information on aTNF therapies was delivered equally by consultants (221;83%) and IBD nurses (209;79%). Of patients who saw both (n = 123), it was nurses (76;62%) rather than doctors (47;38%) who had the greatest influence over the final decision (p = 0.0089). 53% of all patients (n = 140) conducted their own research; most commonly using patient organisation(45%) and drug company websites (23%).
C: Drug factors(n = 287). The most important drug factor which influenced choice of aTNF was place of administration (154; 54%) with 79% (121/154) favouring home rather than hospital treatment. In the free text comments (n = 90), 30% (27) patients stated they preferred ADA as it required them to take “less time off work” and “avoided hospitals”.
Conclusion Physicians and nurses need to ascertain if their patients feel strongly about which aTNF treatment they receive, and try to facilitate these preferences where appropriate. Clearly some patients would rather their team made this decision for them. IBD nurses play a crucial role in this process and have significant influence over patient decisions. Patients value the ability to receive their treatment at home, although home IFX infusions may provide a cost effective alternative.1Online resources are commonly used by patients - healthcare teams need to be aware of their content and guide patients towards reliable sources.
Reference 1 Kuin S, et al. Remicade infusions at home: an alternative setting of infliximab therapy for patients with Crohn’s. Eur J Gastroenterol Hepatol 2016;28(2);222–5. doi:10.1097/MEG.0000000000000530
Disclosure of Interest G. Walker Consultant for: AbbVie SpR advisory board, Speaker bureau with: Dr Falk Pharma, Conflict with: Educational meeting,travel, accommodation MSD, G. Heap Grant/research support from: AbbVie, Dr Falk Pharma, and Tillotts Pharma UK, Consultant for: AbbVie SpR advisory board, C. Bewshea Grant/research support from: AbbVie, MSD, T. Ahmad Grant/research support from: Unrestricted educational grant/consultancy fees for AbbVie, Merck, Takeda, NAPP, and Celltrion, P. Irving Grant/research support from: AbbVie, MSD., Consultant for: AbbVie, MSD, Vifor, Genentech Inc., Takeda, Warner Chilcott, Falk and Pharmacosmos, Speaker bureau with: AbbVie, MSD, Ferring, Warner Chilcott, Shire and Johnson and Johnson, J. Goodhand: None Declared