DOP032 Crohn’s disease patients’ perspectives towards de-escalating immunosuppressive therapy: a comparative French and American survey

Abstract

Background and Aim: When patients with Crohn's disease (CD) are in remission on combination therapy including an anti-tumor necrosis factor (TNF) agent and an immunomodulator (IM), a frequent question is if it is appropriate to stop one of these medications. The aim of this study was to understand patients’ perspectives on stopping therapy for CD when in remission, and to identify differences between French and United States (US) patient groups. Methods: To develop a questionnaire about stopping therapy, a focus group of patients with CD was conducted in the US. The questionnaire was then distributed to patients from France and the US. Patients from France were identified from both the St-Antoine cohort and the Association Francois Aupetit (AFA) database. Patients from the US were identified from the Crohn's and Colitis Foundation of America (CCFA) Partners cohort. Results: 410 patients with CD from the US (113) and France (297) completed the questionnaire. Their median age was 37, and 75% of respondents were women. The majority of patients from France and the US had CD for longer than 10 years. French patients were more likely than those in the US to consider stopping combination therapy if recommended by their doctor (69% vs 48%, p<0.01). When asked which prescription they would prefer to stop, most patients in the US and France preferred to stop the IM (53% US, 47% France) as opposed to anti-TNF (26% US, 28% France). About a quarter of patients (26%) are unwilling to accept any chance of a disease flare when de-escalating therapy. Additionally, over a quarter of patients (27%) responded that they would be unwilling to de-escalate therapy if there is any risk of not getting back into remission when restarting treatment for a flare. A majority of patients (56%) responded that they are more concerned about their CD than the risk of cancer associated with treatment. Over 90% of US and French patients would be willing to have blood work every 3 months and over 60% were willing to have an annual MRI to monitor for disease recurrence. Patients in the US were more willing than those in France to have annual colonoscopy to detect early disease recurrence (p<0.01). Conclusion: French patients are more willing to de-escalate therapy than US patients, and patients in both the US and France prefer de-escalating from combination therapy to biologic monotherapy. However, a sizeable minority of patients is not willing to accept any risk of future flares or loss of response to therapy when considering de-escalation. Both patient groups are open to regular testing to assess for disease recurrence after de-escalation.