A shared decision-making conversation between a healthcare provider and patient surrounding biologic and small-molecule therapies for inflammatory bowel disease (IBD) is crucial when deciding on the best treatment options, according to Welmoed K. van Deen, PhD. “Patients’ preferences are determined by a wide variety of medication characteristics, and these preferences are highly individualized,” she says. “Therefore, it is important to discuss these factors with individual patients to ensure the elected medication regimen is best aligned with their preferences.”

For a paper published in Inflammatory Bowel Disease, Dr. van Deen and colleagues sought to examine patient decision-making processes surrounding biologic and small-molecule therapies in a cohort of 1,077 patients from the United States, Canada, and the United Kingdom using conjoint analysis (CA). “Recent drug approvals have increased the number of therapies available for IBD, making the landscape difficult for patients to navigate,” she notes. “The main objective of our research was to understand what determines the medication preference of patients with IBD when selecting from available biologic and small-molecule therapies.”

Treatment Efficacy Is Most Important Decision-Making Factor

As part of a survey included in the study, patients were asked to choose between several hypothetical medications that differed in terms of efficacy, side-effects, mode of administration, and mechanism of action. The researchers then analyzed responses to assess the relative importance of these different medical characteristics for patients with IBD.

“Our research showed that for patients with IBD, efficacy is generally the most important medication characteristic when considering biologic and small-molecule therapies,” Dr. van Deen says. “Individual side effects—such as risks of lymphoma, shingles, serious infection, and increased cholesterol—were deemed less important than efficacy. However, all side effects combined did determine more than 50% of patients’ preferences. The relative importance of various medication characteristics differed highly between patients, and while we were able to identify some groups for whom specific medication characteristics were more important than for other groups, preferences appeared to be highly individualized.”

All respondents answered 30 CA questions, Dr. van Deen explains, each showing different medication profiles. “For example, one profile might have indicated a medication that was relatively more effective, while another scenario showed one with less side effects,” she says. “By varying the different medication characteristics, we were able to identify which characteristics were the most important in patients’ decision-making processes.”

After participants completed the CA questions, the study asked them, “What other things do you consider when choosing a medicine for IBD that were not listed in the previous section?” Dr. van Deen explains that “in their answers, patients described various additional reasons that could affect their preferences, including insurance coverage and out-of-pocket costs, side effects not included in the CA like hair loss and insomnia, administrative considerations like duration of treatment and impact of treatment on daily life, and other factors (Table). These considerations should be noted when helping a patient decide on the best treatment option.”

Characterizing Patient Preference at the Point of Care

Dr. van Deen cited survey sample and recruitment methodology as limitations to the study. “Participants were recruited through an online panel, which likely did not include those who are less computer literate,” she says. “In addition, there are inherent limitations to the use of a survey to assess preferences, as reported preferences might not always be aligned with the decisions that patients make in real life. Therefore, future research should focus on how these results can best be translated to real-life clinical practice.”

The use of shared decision-making tools could help facilitate this transactional step, she continues, as these tools can help characterize individual patients’ preferences at the point of care. “For example, our team recently developed a website where patients with IBD can fill out a short survey to assess their preferences for various biologic medications,” she explains. “Following completion of the survey, a personalized preference report is generated that they can bring to their doctor. The effectiveness of this tool to enhance the shared decision-making conversation is presently being tested in a randomized controlled trial. If proven efficacious, this tool could be updated to incorporate the newer small molecule medications as well.”

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