Treat-to-target concept relevant for most gastroenterologists

The majority of Australian gastroenterologists are aware of the treat-to-target paradigm in ulcerative colitis but only two thirds consider the concept relevant to their clinical practice.

Not surprisingly, the survey of 61 gastroenterologists from four teaching hospitals in South Australia found familiarity with the guideline endorsed concept was strongly related to its perceived relevance.

Clinicians who were familiar with the concept were five and a half times more likely to find the concept relevant in their day-to-day practice.

For those who did not find it relevant the most frequent reasons given were, “at what cost” concerns about exposing patients to the toxicities of stronger therapies, limitations in accessing therapy and the implications of more frequent and potentially more invasive investigations.

Most survey respondents reported using objective measures of disease activity to guide therapy in their ulcerative colitis patients.

Almost 80 percent said they used endoscopy and histology and over 90 percent said they used a biomarker.

“It’s notable that more objective measures of quality of life were only used in the minority of cases, ” said Dr Scott Schoeman who presented the findings to delegates here at AGW2016.

The survey results also revealed that over half of the gastroenterologists regarded histological healing as the optimal treatment target, with endoscopic remission selected by almost one-third.

Reasons given included: the target reduced colorectal cancer risk and led to better outcomes, was the “most accurate” and “in combination with endoscopic remission defines absence of measurable disease”.

When asked how well clinicians felt they were achieving treatment targets they reported succeeding in achieving remission in almost half of their patients across all measures.

But these figures differed quite substantially from real-world data, Dr Schoeman said.

“There is clearly a significant gap between perceptions and practice,” he said.

“Unless this gap is made known [to clinicians] there is a significant barrier to improving practice… clinicians can’t solve a problem that they are not aware of”.

Treat-to-target strategy is set out in the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) program published last year by the International Organization for the Study of Inflammatory Bowel Diseases.

The target for UC is clinical/patient-reported outcome (PRO) remission (defined as resolution of rectal bleeding and diarrhea/altered bowel habit) and endoscopic remission (defined as a Mayo endoscopic subscore of 0-1). Histological remission is considered as an adjunctive goal.

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