Understanding Patient and Gastroenterologist Preferences at the Time of Treatment Escalation to First-Line Advanced Therapy in Ulcerative Colitis: A Discrete Choice Experiment in Five European Countries.

BACKGROUND

With guidelines recommending earlier advanced therapy (AT) use after 5-ASA failure for patients with moderately-to-severely active ulcerative colitis (UC), it is important to explore treatment preferences at the point of escalation to first-line AT.

METHODS

A web-based discrete choice experiment (DCE) survey was administered to AT-naïve patients with moderately-to-severely active UC and gastroenterologists in 5 European countries. Treatment attributes included time until symptom improvement, probability of remission and corticosteroid-free remission, risks of cancer, serious infection, and major adverse cardiovascular events (MACE), and mode of administration. Preference weights, relative attribute importance (RAI), and maximum acceptable risk were estimated. A latent class analysis explored preference heterogeneity.

RESULTS

Probability of remission at 1 year was the most important attribute for patients (N = 514; RAI = 45.3%) and gastroenterologists (N = 397; RAI = 48.5%). Five-year cancer risk was the second most important attribute for patients (RAI = 11.8%) and third for gastroenterologists (RAI = 10.9%). RAI of MACE was higher for patients than gastroenterologists (10.6% vs. 6.8%). Both were willing to accept risks for increased probability of remission. Latent class analysis identified 4 groups of patients and 2 groups of gastroenterologists with distinct preferences. The relative importance of efficacy was higher compared with safety in latent classes representing 80% of patients.

CONCLUSION

Clinical remission was most important to patients and gastroenterologists, and both were willing to accept some risk in exchange for the benefits of AT. However, some heterogeneity in preferences was observed. To support patient-centered, guideline-concordant care, gastroenterologists should discuss escalation to AT with patients not well-controlled on conventional therapy, incorporating individual preferences through shared decision-making.