Acceptability of a ‘treat to target’ approach in inflammatory bowel disease to patients in clinical remission

BackgroundA ‘treat to target’ approach aiming for remission of clinical symptoms and absence of mucosal inflammation has been proposed in inflammatory bowel disease (IBD). We aimed to establish whether patients with IBD in clinical remission find this approach acceptable.MethodsPatients in glucocorticosteroid-free clinical remission underwent a face-to-face structured, quantitative interview and rated the acceptability of treat to target on a 10-point Likert scale. We analysed factors associated with agreement to treat to target.ResultsThe cohort comprised 298 patients (144 Crohn’s disease, 136 ulcerative colitis, 18 IBD-unclassified). Elevated C-reactive protein was found in 24.4% and elevated faecal calprotectin in 17.7%. Overall, 66.2% of patients rated a treat to target approach as acceptable (Likert scale ≥8). Acceptable treatment aims for patients were avoidance of flare, hospitalisation, surgery and colorectal cancer. Using binary logistic regression analysis the following were not predictive of accepting a treat to target approach: age, diagnosis, disease phenotype, surgical history, disease duration, patient knowledge, adherence, anxiety, depression and patient-reported control of disease. Better adherence to current therapy was associated with accepting a treat to target approach (B=0.16, p=0.039).ConclusionIn a cohort of patients in clinical remission, where this strategy is most relevant, two-thirds of patients agreed with treat to target. Patients with better current adherence were more likely to accept treat to target. Patient education and counselling materials will need to be developed to convince a substantial minority of patients of the importance of treat to target.

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The Majority of Patients With Inflammatory Bowel Disease in Clinical Remission Has Mucosal Inflammation

Gastroenterology ◽

10.1016/s0016-5085(11)63221-6 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-776 ◽

Cited By ~ 1

Author(s):

Judith E. Baars ◽

Veerle J. Nuij ◽

Bas Oldenburg ◽

Ernst J. Kuipers ◽

Christien J. van der Woude

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Clinical Remission ◽

Mucosal Inflammation ◽

Inflammatory Bowel

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P219 Disease-specific avoidance is a predictor for fatigue in inflammatory bowel disease patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.348 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S250-S252

Author(s):

L Fierens ◽

I Van de Pavert ◽

M Walentynowicz ◽

S Coenen ◽

P Geens ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Clinical Remission ◽

Stool Frequency ◽

Avoidance Behaviour ◽

Tertiary Referral Centre ◽

Cross Sectional ◽

Patient Reported ◽

Inflammatory Bowel ◽

Disease Specific

Abstract Background A substantial group of patients with inflammatory bowel disease (IBD) experience fatigue, even while in clinical remission. At present, disease-specific behaviours that maintain or worsen symptom burden including fatigue have not been explored. We developed a questionnaire evaluating IBD-specific avoidance behaviour and investigated how this relates to self-reported fatigue. Methods This study was a close collaboration between the psychology and gastroenterology department of our tertiary referral centre. A 72-item IBD-specific avoidance behaviour questionnaire (IBD-B) was generated based on literature review and input from clinicians and a patient focus group (n = 10). Between July 2018 and March 2019, 500 consecutive IBD patients were included at our infusion unit (wave 1) (participation rate 79%, 48% male, 66% Crohn’s disease (CD), median age 40). Patients completed the 72-item IBD-B, a demographic questionnaire, patient-reported outcome assessing disease activity (PRO2) and a Visual Analogue Scale (VAS) for fatigue. Test–retest reliability was assessed in 89 patients (54% male, 70% CD, median age of 40) who completed the IBD-B, PRO2 and VAS fatigue scale a second time after 4–12 weeks (wave 2). Clinical remission was defined as an abdominal pain score ≤1 and a liquid to very soft stool frequency ≤1.5 in CD patients and as no rectal bleeding and a stool frequency ≤1 in patients with ulcerative colitis (UC). A principal component analysis (PCA) was then used to reduce the number of items and investigate the underlying factor structure of the IBD-B. The predictive value of IBD-specific behaviours for fatigue was finally investigated both cross-sectionally and prospectively. Results At wave 1, 46% and 69% of CD and UC patients, respectively, were in clinical remission. PCA suggested a reduction of the 72-item to a final 25-item IBD-B and a seven-factor solution for use in clinical practice (loading factors >0.5, Table 1). The final 25-item IBD-B showed good psychometric properties. The median (IQR) total IBD-B and fatigue scores were, respectively, 29 (40-20) and 52 (77-25) for patients in clinical remission compared with 38 (48-28) and 74 (87-50) for patients not in clinical remission (both p < 0.01). Both cross-sectional and prospective significant correlations between IBD-B factors and fatigue were demonstrated (Table 2). Conclusion The IBD-B is a valuable tool to accurately measure IBD-specific avoidance behaviour in IBD patients. IBD patients without clinical remission report higher IBD-B values and show a higher correlation between avoidance behaviour and fatigue. Further research should now focus on identifying predictors for fatigue in IBD patients in clinical remission.

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Su1822 POOR PATIENT-REPORTED OUTCOMES WERE OBSERVED IN PATIENTS IN THE CORRONA INFLAMMATORY BOWEL DISEASE REGISTRY, DESPITE BEING IN CLINICAL REMISSION

Gastroenterology ◽

10.1016/s0016-5085(20)32350-7 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-662-S-663

Author(s):

Sara N. Horst ◽

David Hudesman ◽

Joe Zhuo ◽

Ryan W. Harrison ◽

Rachel H. Mackey ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Clinical Remission ◽

Patient Reported Outcomes ◽

Disease Registry ◽

Poor Patient ◽

Patient Reported ◽

Inflammatory Bowel

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MICROBIAL SHIFTS ARE ASSOCIATED WITH PATIENT-REPORTED SYMPTOMS IRRESPECTIVE OF MUCOSAL INFLAMMATION IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Gastroenterology ◽

10.1053/j.gastro.2021.01.149 ◽

2021 ◽

Vol 160 (3) ◽

pp. S55-S56

Author(s):

Jennifer Hellmann ◽

Allison Ta ◽

David Haslam ◽

Kathleen Lake ◽

Ramona Bezold ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Pediatric Patients ◽

Mucosal Inflammation ◽

Patient Reported ◽

Inflammatory Bowel

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High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izy378 ◽

2018 ◽

Vol 25 (7) ◽

pp. 1248-1254 ◽

Cited By ~ 4

Author(s):

Edward L Barnes ◽

Millie D Long ◽

Michael D Kappelman ◽

Christopher F Martin ◽

Robert S Sandler

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Clinical Remission ◽

Strong Association ◽

Patient Activation ◽

Measurement Information ◽

Patient Reported ◽

Education Status ◽

Inflammatory Bowel

Abstract Background High levels of patient activation (having the knowledge, skills, and confidence to effectively manage one’s care), have been associated with improved outcomes in many chronic conditions. There have been few studies of the effects of activation in patients with inflammatory bowel disease (IBD). We performed a large, prospective Internet-based study to assess the relationship between patient activation level and clinical remission in patients with Crohn’s disease or ulcerative colitis. Methods We administered the Patient Activation Measure (Insignia Health) to 1486 cohort participants. Patients completed a follow-up survey within 13 months (median, 189 days). We collected demographic and clinical data; anxiety and depression were assessed using Patient-Reported Outcomes Measurement Information System instruments. We used bivariate analyses and multivariable logistic regression to identify characteristics associated with low or high patient activation and to evaluate the association between levels of patient activation and subsequent disease activity. Results Higher anxiety (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.29–0.36) and depression (aOR, 0.33; 95% CI, 0.29–0.37) scores were associated with a decreased odds of high patient activation. After we adjusted for education status, smoking, medication use, and other confounders, we found that patients with high activation at baseline were more likely to be in clinical remission during the follow-up period (aOR, 1.71; 95% CI, 1.20–2.45). Conclusions In a large, prospective Internet-based cohort of patients with IBD, we found a strong association between patient activation and clinical remission. These findings suggest that patient activation affects disease outcomes.

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