P574 Limitations and difficulties in using anti-TNF-alpha agents in inflammatory bowel disease. A survey of the Italian Group for Inflammatory Bowel Disease (IG-IBD)

Abstract

Background: It is known that Italian physicians managing IBD use anti-TNFalpha agents in a less extensive way in comparison with European specialists. The aim of the study was to investigate the reasons and situations limiting the use of these medications. Methods: A questionnaire was submitted to physicians attending the National Congress and the Residential Courses of IG-IBD. Results: 280 physicians (156 men) completed the questionnaire. Mean age ± SD was 44.4±10.7 years; 95 (33.9%) were working in Academic hospitals. Behavior about anti-TNF use (49, 17.5% did not answer this question) is: 176 (62.9%) use anti-TNF every time is needed; 29 (10.4%) have limited budget and are not able to treat all the patients needing the drug, 5 (1.8%) can not to use the drug, 2 (0.7%) do not use anti-TNFalpha. The most important limitations in using anti-TNFalpha (55 did not answer this question, 19.6%) are: fear of side effects (88, 31.4%), costs (86, 30.7%), administrative and/or bureaucratic limitations (18, 6.4%), lacking of dedicated staff (14, 5.0%), lacking of solid scientific data (5, 1.8%), inefficacy (4, 1.4%), fear of poor compliance (3, 1.1%), other (7, 2.5%). The most feared side effect (48 did not answer this question, 17.1%) is: opportunistic infection (106, 37.9%), neoplasm (59, 21.1%), allergic reactions (29, 10.4%), TB reactivation (17, 6.1%), onset of autoimmune disease (17, 6.1%), other (4, 1.4%). On a 5-point Likert scale, the less satisfying features of anti-TNFalpha were: costs (2.2±1.1), easy prescription (2.7±1.1), easy administration (2.9±1.1). Conclusions: Practical and cultural factors appear to be a limitation in prescribing anti-TNF alpha agents by Italian physicians. Improvement of logistics and knowledge is a must to allow the best management of IBD patients.