Gastroenterologists prescribing of infliximab for Crohn's disease: A national survey

Abstract

Objective. We surveyed a national sample of gastroenterologists (GIs) to determine whether they are utilizing immunomodulators (IM) prior to infliximab (IFX) and prescribing maintenance IFX when treating Crohn's Disease (CD), as recommended by gastroenterology society guidelines and the package insert. Methods. An 18-item questionnaire was developed and validated by four experts in the field. The survey was emailed to 4,515 GIs who are members of the American Gastroenterology Association (AGA). Selected GIs were randomly assigned to each of three study arms. Two of the three study arms received an incentive. Each study arm received a total of six email blasts of the survey. Bivariate and multivariate analyses were performed on the outcomes of interest and important covariates. Results. A total of 305 out of 4,515 (6.7%) eligible GI's responded to the survey. The majority (82.6%) of respondents reported using IFX. 69.5% of respondents would use an IM prior to IFX, 85.6% would prescribe maintenance IFX, and 62.3% reported both ("on-label" use of IFX). GIs with a volume of CD patients >6%, practicing in an academic setting, and prescribing IFX a few times per year were significantly more likely to report the use of IM prior to IFX (OR=1.96, 5.11 and 3.46, respectively). GIs residing in the Midwest and infusing IFX in their office were significantly more likely to report the use of maintenance IFX (OR=11.70 and 4.55, respectively). GIs practicing in an academic setting, residing in the Midwest, and prescribing IFX a few times per year were significantly more likely to report the "on-label" use of IFX (both use of IM prior to IFX and maintenance IFX), (OR=4.56, 2.18 and 2.25, respectively). The use of an incentive significantly improved response rates (p=0.03; absolute difference=39%). Conclusion. The majority of GIs reported utilizing an IM prior to IFX and prescribing maintenance IFX. However, 38% of respondents failed to report both use of an IM prior to IFX and use of IFX maintenance therapy. GIs practicing outside of the Midwest and outside of an academic setting may need additional training regarding proper prescribing of IFX to improve outcomes in patients with CD