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P187 Cognitive behavioural profiles from patients on biologics: not what you might think

I. Y. Liew1, G. Chung-Faye1, P. Dubois1, L. Medcalf1, A. Simpson2, J. Hutton2, C. Jordan2, M. Hotopf2, B. Hayee*1

1King’s College Hospital NHS Foundation Trust, Gastroenterology, London, United Kingdom, 2King’s College London, Department of Psychological Medicine, London, United Kingdom


Biologic therapies for IBD represent a significant advance in management. Many patients experience better disease control and quality of life. Physician and patient preferences (particularly for the route of administration) are central to uptake and adherence. Although patients seem to prefer subcutaneous (SC) administration,1 there remains a significant cohort who select intravenous (IV) therapy and those who have this route ‘chosen’ for them for non-disease-related reasons (eg, concerns over adherence or safety). This cohort study was conducted to elicit psychosocial factors associated with the route of biologic administration.


Patients were identified from our electronic database: eligibility criteria, optimised, stable dose of anti-TNF and no use of corticosteroids, for at least 3 months; normal B12, ferritin and vitD serum level; and faecal calprotectin < 250 mcg/g. In line with institution practice, patients were offered an informed, free choice of the route of administration. If IV was prescribed, the reason for doing so was recorded as part of routine clinical care. Only those in whom ‘patient preference’ cited were questioned, and the following questionnaires applied: Patient Health Questionnaire (PHQ-9); Generalised Anxiety Disorder (GAD-7); Multidimensional Health Locus of Control (MHLC); Cognitive and Behavioural Responses to Symptoms (CBSRQ-41); Work and Social Adjustment Scale (WSAS); and IBD control-8 questionnaire (IBDC).2


In total, 24 patients were on adalimumab (SC group 13F, 36.0 ± 12.3 yr, 5 UC), with 25 on remicade (RMC) and 10 on vedolizumab (VDZ). Patients on RMC and VDZ (n = 35; 17F, 38.5 ± 13.4 yr, 13 UC) were analysed together (IV group). There were no significant differences in demographics or numbers of patients reporting PHQ-9 or GAD-7 scores > 10 (moderate symptoms), but 15% exceeded this cut-off. Median IBDC score lower in SC (7 vs 9, p = 0.06). MHLC responses were identical, whereas SC returned more unhelpful responses in the Cognitive and Behavioural Responses to Symptoms Questionnaire (CBRSQ)-41 total score (79.8 vs 66.7, p < 0.05), as well as in the symptom focus and catastrophisation domains (p vs IV = 0.005, 0.001, respectively).


SC patients were significantly more unhelpfully focused on symptoms (‘I think a great deal about my symptoms’) and catastrophising (‘I will never feel right again’), with the total CBRSQ score correlating with IBDC (r = 0.42, p = 0.0008). Locus of control (LOC) was identical between the 2 groups, suggesting an unmet need for patient support in SC. It will be valuable to determine if these differences exist at the start of treatment or if they arise during the course of therapy.


[1] Vavricka SR Bentele N, Scharl M, et al. Systematic assessment of factors influencing preferences of Crohn’s disease patients in selecting an anti-tumor necrosis factor agent (CHOOSE TNF TRIAL). Inflamm Bowel Dis 2012; 18:1523–530.

[2] Bodger K, Ormerod C, Shackcloth D, et al. Development and validation of a rapid, generic measure of disease control from the patient’s perspective: the IBD-Control questionnaire. Gut 2014;63:1092–102.