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

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http://www3.interscience.wiley.com/cgi-bin/abstract/116330107/ABSTRACT?CRETRY=1 & SRETRY=0

Original Article

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

D. Kennedy, MD, PhD 1 2, Theresa To, PhD 1 2, A. Hillary Steinhart, MD 1 2 3, Allan Detsky, MD, PhD 1 2 3, Hilary A. Llewellyn-, PhD 1 4, Robin S. McLeod, MD 1 3 *

1Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ontario Canada2Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada3Department of Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada4Centre for the Evaluative Sciences, Department of Community and Family Medicine, Dartmouth College, Hanover, New Hampshire

email: Robin S. McLeod (rmcleod@...)

*Correspondence to Robin S. McLeod, Department of Surgery, Mount Sinai Hospital, Suite 449, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada

Funded by: Crohn's and Colitis Foundation of Canada Medical Research Council of Canada

Keywords

Crohn's disease • maintenance therapy • minimal clinically important difference

Abstract

Background: Treatment decision making for postoperative Crohn's disease is complex because of the increasing number of maintenance therapies available with competing risk-benefit profiles. The main objective of this study was to determine the distribution of patients' preferences for selected postoperative maintenance therapies.

Methods: The study was a cross-sectional survey in which patients with Crohn's disease completed a standardized interview. Each participant completed 5 tasks that compared: (1) no medication and 5-ASA, (2) fish oil and 5-ASA, (3) metronidazole and 5-ASA, (4) budesonide and 5-ASA, and (5) azathioprine and 5-ASA. For each task, the minimum change in treatment effect size between the 2 treatments that the participant considered worthwhile was determined

Results: The distribution of the participants' preference scores varied widely for each task. When fish oil, metronidazole, budesonide, and azathioprine were considered equally effective to 5-ASA, 92.9%, 28.8%, 38.4%, and 19% of the participants, respectively, preferred these medications relative to 5-ASA. These percentages increased to 98.4%, 54.8%, 61.9%, and 50.8%, respectively, when fish oil, metronidazole, budesonide, and azathioprine were considered to offer a 5% absolute risk reduction relative to 5-ASA. Regression analysis did not identify any clinical or demographic variables predictive of the participants' treatment preferences.

Conclusions: The participants' preferences for postoperative maintenance therapies were widely distributed, and no clinical or demographic factors predicted these preferences. This emphasizes the need for effective communication between physician and patient in order to select the treatment options most consistent with a patient's informed preferences.

(Inflamm Bowel Dis 2007, Volume 14, Issue 2 , Pages 224 - 235)

Received: 22 June 2007; Accepted: 31 August 2007

Digital Object Identifier (DOI)10.1002/ibd.20300