Patterns of conventional therapy use and advanced therapy initiation drivers in inflammatory bowel disease

Accumulating evidence and conditional regional guidelines support early initiation of advanced therapy (AT) in Crohn's disease (CD) and ulcerative colitis (UC). Nonetheless, AT utilization in real-world clinical practice remains limited.

The aim of this study was to assess barriers for AT initiation among surveyed gastroenterologists.

Quantitative survey with a multimodal approach.

In total, 142 gastroenterologists (30 each from Germany, Italy, and the United Kingdom; 52 from the United States) were surveyed from June to November 2023 to capture drivers of AT initiation. They were classified as low or high conventional therapy (CT) cyclers (using 0-1 or ⩾2 CT cycles before initiating AT, respectively). Behavioral analysis was performed employing a COM-B (Capability, Opportunity, Motivation, Behavior) model.

Across countries, 67.3%-90.0% of surveyed gastroenterologists agreed that AT initiation should be early enough to modify the trajectory of disease. Nonetheless, the majority (51.9%-80.0%) of surveyed gastroenterologists were high CT cyclers (except those in the United States treating CD (36.5%)). When surveyed about the importance of factors for initiating AT in patients with UC, high cyclers placed greater importance on treatment familiarity (+8.1%) than low cyclers and preferred to exhaust other treatment options first (+8.9%). Alternatively, low cyclers placed more importance on patient preference (+15.7%) and peer recommendations (+12.9%) than high cyclers. There were fewer differences in AT prescription drivers between low and high CT cyclers for CD than UC.

High CT cyclers placed an overall lower value on AT, suggesting clinical beliefs played a determining role in AT initiation among surveyed gastroenterologists.