Introduction Physician and patient preferences (particularly for the route of administration; RoA) are central to uptake and adherence of biologic therapy in IBD. While patients reportedly prefer subcutaneous (SC) administration , there remains a significant cohort who select intravenous (IV) therapy if offered. This cohort study was conducted to elicit psychosocial factors associated with the route of biologic administration.
Method Patients offered a free choice of RoA, with quiescent disease were identified from our electronic database: optimised, stable dose of biologic and no use of corticosteroids, for ≥3 months; normal B12, ferritin and vitD serum level; faecal calprotectin <250 mcg/g. The following questionnaires were then applied at their next infusion or clinic visit: Patient Health (PHQ-9); Generalised Anxiety (GAD-7); Multidimensional Health Locus of Control (MHLC); Cognitive and Behavoural Responses to Symptoms (CBSRQ-41); Work and Social Adjustment (WSAS); IBD control-8 (IBDC) .
Results 24 patients were on adalimumab (SC group; 13F, 36.0±12.3 years, 5UC), with 25 on Remicade (IV group: 17F, 38.5±13.4 years (IV group). There were no significant differences in demographics, or numbers of patients reporting PHQ-9 or GAD-7 scores>10 (moderate symptoms), but 11 (22%) exceeded this cut-off. MHLC responses were identical, while SC patients report lower IBDC (7 vs 9, p<0.05) and more unhelpful responses in the CBRSQ-41 (total score 79.8 vs 66.7, p<0.01) as well as in the symptom focus, embarrassment avoidance and catastrophisation domains (p vs IV<0.0005,<0.05 and<0.0005 respectively).
Conclusion SC patients were significantly more unhelpfully focused on symptoms (“I think a great deal about my symptoms”) and catastrophising (“I will never feel right again”) as well as reporting engaging in behaviours to avoid embarrassment. Despite quiescent disease, ‘unhelpful’ higher CBRSQ scores correlated with worse disease-related QOL (p<0.001, figure 1), suggesting an unmet need for patient support in SC. It will be valuable to determine if these differences exist at the start of treatment, or whether they arise during the course of therapy.
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Disclosure of Interest None Declared
- Biologic therapy
- quality of life