Do patients consider postoperative maintenance therapy for Crohn's disease worthwhile?

Area of Science:

• Gastroenterology
• Clinical Therapeutics
• Patient-Reported Outcomes

Background:

• Postoperative Crohn's disease management involves complex decisions due to numerous maintenance therapies.
• Evaluating competing risk-benefit profiles of available treatments is challenging.

Purpose of the Study:

• To determine patient preferences for various postoperative maintenance therapies for Crohn's disease.
• To understand the distribution of patient preferences among different treatment options.

Main Methods:

• A cross-sectional survey design was employed.
• Patients with Crohn's disease completed standardized interviews assessing preferences between 5-ASA and other medications (fish oil, metronidazole, budesonide, azathioprine).
• Minimum worthwhile change in treatment effect size was determined for each comparison.

Main Results:

• Patient preferences for postoperative Crohn's disease maintenance therapies showed wide distribution.
• When treatments were equally effective, a significant majority preferred fish oil (92.9%) over 5-ASA, while budesonide (38.4%), metronidazole (28.8%), and azathioprine (19%) showed lower preference.
• Preferences shifted, with higher percentages favoring budesonide (61.9%), fish oil (98.4%), azathioprine (50.8%), and metronidazole (54.8%) when a 5% absolute risk reduction was considered.

Conclusions:

• Patient preferences for postoperative Crohn's disease maintenance therapies are highly variable.
• No specific clinical or demographic factors were identified as predictors of treatment preferences.
• Effective physician-patient communication is crucial for selecting treatments aligned with informed patient preferences.