Practice pattern variability in the management of acute severe colitis: A UK provider survey

Sebastian, Shaji; Lisle, Jessica; Subramanian, Sreedhar; Dhar, Anjan; Shenoy, Achut; Limdi, Jimmy; Butterworth, Jeffrey; Allen, Patrick B; Samuel, Sunil; Moran, Gordon; Shenderey, Richard; Parkes, Gareth; Raine, Tim; Lobo, Alan J; Kennedy, Nicholas A

Abstract

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. Introduction: Lack of comparative trial data on dosing regimens of infliximab in patients with acute severe ulcerative colitis (ASUC) failing intravenous corticosteroids has resulted in variability of rescue regimes in ASUC with potential impact on clinical outcomes. We aimed to evaluate practice variability and physician perspectives in decision-making with rescue therapy. Methodology: An internet-based survey of members of the inflammatory bowel disease (IBD) section of the British Society of Gastroenterology was conducted. The survey evaluated provider characteristics and general practice in the setting of ASUC, followed by a vignette with linked questions. Results: The response rate of the survey was 31% (209/682 IBD section members). 134 (78%) reported they would use standard infliximab dose (5 mg/kg) while 37 (22%) favoured a higher front-loading dose of 10 mg/kg citing low albumin, high C-reactive protein as their reason for their preference. IBD specialists chose the higher front-loading dose more often compared with other gastroenterologists (p=0.01) In the specific case vignette, accelerated induction (AI) was favoured by 51% of the respondents while 25% used the standard induction regime and 19% favoured colectomy. IBD specialists more often favoured AI compared with other gastroenterologists (p=0.03) with the main reason being presence of predictors of low infliximab levels (74%). The reasons cited for favouring standard induction (n=57) included lack of evidence for AI (18), their usual practice (11), unlicensed regime (7), and safety concerns (4). Conclusions: There are significant variations in practice in the use of infliximab rescue therapies with an urgent need for development of care pathways to standardise practice.

Citation

Sebastian, S., Lisle, J., Subramanian, S., Dhar, A., Shenoy, A., Limdi, J., Butterworth, J., Allen, P. B., Samuel, S., Moran, G., Shenderey, R., Parkes, G., Raine, T., Lobo, A. J., & Kennedy, N. A. (2019). Practice pattern variability in the management of acute severe colitis: A UK provider survey. Frontline Gastroenterology, https://doi.org/10.1136/flgastro-2019-101277

• Journal Article Type: Article
• Acceptance Date: Jul 31, 2019
• Online Publication Date: Aug 17, 2019
• Publication Date: Aug 17, 2019
• Deposit Date: Sep 4, 2019
• Publicly Available Date: Sep 11, 2019
• Journal: Frontline Gastroenterology
• Print ISSN: 2041-4137
• Electronic ISSN: 2041-4145
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1136/flgastro-2019-101277
• Keywords: Acute severe colitis, Rescue therapy, Infliximab, Accelerated rescue, provider survey
• Public URL: https://nottingham-repository.worktribe.com/output/2561341
• Publisher URL: https://fg.bmj.com/content/early/2019/08/16/flgastro-2019-101277
• Additional Information: This article has been accepted for publication in Frontline Gastroenterology, 2019 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/flgastro-2019-101277.; Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org
• Contract Date: Sep 4, 2019