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P248. Perceptions of the risks of continuation and cessation of maintenance therapy among patients with inflammatory bowel disease

D. Kevans, F. Zeb, K. Boland, M. Forry, N. Godwin, G. Harewood, S. Patchett, F.E. Murray

Beaumont Hospital, Dublin 9, Ireland

Aim: IBD patients frequently require long-term treatment with potentially toxic medications, while discontinuation of maintenance immunomodulators and biologic therapies remains controversial. The aim of this study was to assess patient knowledge of the risks of continuation and cessation of maintenance therapies for inflammatory bowel disease.

Materials and Methods: Questionnaires relating to the risks of continuation and cessation of commonly used maintenance IBD treatments (aminosalicylates, corticosteroids, immunomodulators, biologics) were completed by IBD patients attending gastroenterology clinics at a teaching hospital.

Results: Eighty-four patients (42 male) with a median (interquartile range) age of 38 (30–49) years were included: 41 Crohn's disease and 43 ulcerative colitis. Aminosalicylates were ranked as the safest mediation [median 1.3 (IQR 0.5–2.5)], then biologics [5.2 (1.5–10)], then AZA/6MP [5.7 (2.4–8)], with steroids considered the least safe [7.9 (4.5–9.1)]. 50%, 43%, 64% and 83% of patients reported no knowledge of the long-term safety of aminosalicylates, corticosteroids, AZA/6MP and biologics respectively. The greatest perceived risk of continuation of longterm therapy with: aminosalicylates, was bone marrow suppression [median 4.9 (IQR 1–8.8)]; AZA/6MP, was lymphoma [7.1 (3.4–9)]; and biologics, was risk of infection [9.8 (4.5–10)]. The greatest perceived risk of cessation of long-term therapy with: aminosalicylates, was requirement for steroids use [8.6 (6.6–10)]; AZA/6MP, was risk of disease flare [9 (7.2–10)], while with biologics, all risks of cessation (steroid requirement, disease flare, hospitalisation & surgery) were perceived to be equally high [10 (IQRs 6.7–10)].

Conclusion: The majority of IBD patients have no knowledge of the long-term safety of common IBD medications. The risk of cessation of maintenance therapy, in particular biologics is perceived to be high. Better education of IBD patients with regards to the risks and benefits of maintenance therapy is required so that informed decisions can be made which involve both patient and gastroenterologist.