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P326. Use of anti-TNF-alpha therapy in Crohn's disease patients in clinical practice: results of a nation-wide survey (named CROSSOVER) conducted in Spain

A. Gutierrez1, I. Marín-Jiménez2, E. Ricart3, J. Hinojosa4, 1Hospital General Alicante, Alicante, Spain, 2Hospital Gregorio Marañón, Madrid, Spain, 3Hospital Clínic-CiberEHD, Barcelona, Spain, 4Hospital Manises, Valencia, Spain

Background

Anti-TNF-alpha drugs are a fundamental part of the current therapeutic arsenal for Crohn's disease (CD). The objective of this project is to describe the use of anti-TNF-alpha drugs for CD in the routine clinical practice of Spanish gastroenterologists with the goal of identifying subjects to be emphasized in continuing education programs and updating and modifying clinical guidelines.

Methods

Descriptive study based on the information obtained from a 38-question survey (named “CROSSOVER”) with multiple choice options conducted throughout the country. The questionnaire was divided into 5 sections: general data, treatment, following and monitoring, safety and perception of Crohn's disease. The results were sub-analyzed, taking into account super-specialization in inflammatory bowel disease (IBD), years of working experience, number of IBD patients seen, age and gender of the specialist.

Results

236 surveys were collected using a web form. The survey was completed by 37% of general gastroenterologists and 63% of IBD specialists. 28% of physicians follow-up more than 300 patients with CD. The patient profile in which anti-TNF-alpha drugs are used is intolerance to immunomodulating drugs (96%), complex perianal disease (96%), fistulizing disease (63.6%), signs of poor prognosis (54%), and used as prophylaxis in postoperative recurrence (17.4%). Only 20% plan to maintain long-term combination therapy with anti-TNF-alpha plus an immunosuppressant in naive patients following remission. Physicians who treat more than 300 patients de-escalate treatment (78.8%) more frequently than those who follow fewer patients (57.1%, p = 0.002) once improvement was achieved in patients with loss of response. 12% of those surveyed did not order a chest x-ray prior to starting anti-TNF-alpha medication and the PPD-booster was administered by 94%. Half of the non-IBD-specialist gastroenterologists and a third of specialists had any difficulty when prescribing anti-TNF-alpha medications to patients with CD.

Conclusion

A high percentage of Spanish gastroenterologists use anti-TNF-alpha drugs in patients with CD by following current indications in the clinical practice guidelines. There are still controversial aspects, such as maintenance of combined therapy, where a disparity in tendencies was seen.