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Colorectal
Original research
Acceptability of a ‘treat to target’ approach in inflammatory bowel disease to patients in clinical remission
  1. Christian Selinger1,2,
  2. Jenelyn Carbonell1,
  3. John Kane1,
  4. Mandour Omer1,
  5. Alexander Charles Ford1,2
  1. 1 Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2 Leeds Institute of Medical Research at St James's Hopsital, University of Leeds, Leeds, UK
  1. Correspondence to Dr Christian Selinger, Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; christian.selinger{at}web.de

Abstract

Background A ‘treat to target’ approach aiming for remission of clinical symptoms and absence of mucosal inflammation has been proposed in inflammatory bowel disease (IBD). We aimed to establish whether patients with IBD in clinical remission find this approach acceptable.

Methods Patients in glucocorticosteroid-free clinical remission underwent a face-to-face structured, quantitative interview and rated the acceptability of treat to target on a 10-point Likert scale. We analysed factors associated with agreement to treat to target.

Results The cohort comprised 298 patients (144 Crohn’s disease, 136 ulcerative colitis, 18 IBD-unclassified). Elevated C-reactive protein was found in 24.4% and elevated faecal calprotectin in 17.7%. Overall, 66.2% of patients rated a treat to target approach as acceptable (Likert scale ≥8). Acceptable treatment aims for patients were avoidance of flare, hospitalisation, surgery and colorectal cancer. Using binary logistic regression analysis the following were not predictive of accepting a treat to target approach: age, diagnosis, disease phenotype, surgical history, disease duration, patient knowledge, adherence, anxiety, depression and patient-reported control of disease. Better adherence to current therapy was associated with accepting a treat to target approach (B=0.16, p=0.039).

Conclusion In a cohort of patients in clinical remission, where this strategy is most relevant, two-thirds of patients agreed with treat to target. Patients with better current adherence were more likely to accept treat to target. Patient education and counselling materials will need to be developed to convince a substantial minority of patients of the importance of treat to target.

  • Crohn's disease
  • ulcerative colitis
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/flgastro-2019-101366

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    Footnotes

    • Contributors CS designed the study, analysed the data and wrote the draft manuscript. All authors contributed equally to data collection and interpretation of results. All other authors critically reviewed the manuscript.

    • Funding Abbvie provided funding for the study via an unrestricted research grant. AbbVie was not involved in the conduct and analysis of the study, nor the development or review of the manuscript with the authors. This manuscript reflects the opinions of the authors. The authors determined the final content, and all authors read and approved the final manuscript.

    • Competing interests CS has received unrestricted research grants from Warner Chilcott, Janssen and AbbVie, has provided consultancy to Warner Chilcott, Dr Falk, AbbVie, Takeda, Fresenius Kabi and Janssen, and had speaker arrangements with Warner Chilcott, Dr Falk, AbbVie, MSD, Pfizer and Takeda.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved following proportionate review by the NRES Committee East Midlands—Derby (reference: 15/EM/0412). All patients provided written informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. The patient consent obtained does not cover data sharing.

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