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P574 Limitations and difficulties in using anti-TNF-alpha agents in inflammatory bowel disease. A survey of the Italian Group for Inflammatory Bowel Disease (IG-IBD)

Saibeni S.*1, Bezzio C.1, Armuzzi A.2, Bossa F.3, Calabrese E.4, Caprioli F.5, Daperno M.6, Mocciaro F.7, Orlando A.8, Papi C.9, Rispo A.10, Rizzello F.11 IG-IBD

1ASST Rhodense, Gastroenterology Unit, Rho, Italy 2Policlinico Gemelli, Rome, Italy 3Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy 4Policlinico Tor Vergata, Rome, Italy 5University of Milan, Milan, Italy 6Ospedale Mauriziano, Torino, Italy 7Ospedale Arnas Civico, Palermo, Italy 8Ospedale Cervello, Palermo, Italy 9Ospedale San Filippo Neri, Rome, Italy 10Policlinico Federico II, Naples, Italy 11University of Bologna, Bologna, Italy

Background

It is known that Italian physicians managing IBD use anti-TNFalpha agents in a less extensive way in comparison with European specialists. The aim of the study was to investigate the reasons and situations limiting the use of these medications.

Methods

A questionnaire was submitted to physicians attending the National Congress and the Residential Courses of IG-IBD.

Results

280 physicians (156 men) completed the questionnaire. Mean age ± SD was 44.4±10.7 years; 95 (33.9%) were working in Academic hospitals. Behavior about anti-TNF use (49, 17.5% did not answer this question) is: 176 (62.9%) use anti-TNF every time is needed; 29 (10.4%) have limited budget and are not able to treat all the patients needing the drug, 5 (1.8%) can not to use the drug, 2 (0.7%) do not use anti-TNFalpha. The most important limitations in using anti-TNFalpha (55 did not answer this question, 19.6%) are: fear of side effects (88, 31.4%), costs (86, 30.7%), administrative and/or bureaucratic limitations (18, 6.4%), lacking of dedicated staff (14, 5.0%), lacking of solid scientific data (5, 1.8%), inefficacy (4, 1.4%), fear of poor compliance (3, 1.1%), other (7, 2.5%). The most feared side effect (48 did not answer this question, 17.1%) is: opportunistic infection (106, 37.9%), neoplasm (59, 21.1%), allergic reactions (29, 10.4%), TB reactivation (17, 6.1%), onset of autoimmune disease (17, 6.1%), other (4, 1.4%). On a 5-point Likert scale, the less satisfying features of anti-TNFalpha were: costs (2.2±1.1), easy prescription (2.7±1.1), easy administration (2.9±1.1).

Conclusion

Practical and cultural factors appear to be a limitation in prescribing anti-TNF alpha agents by Italian physicians. Improvement of logistics and knowledge is a must to allow the best management of IBD patients.