Author information

1 Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto Toronto, Ontario, Canada.

2 Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

3 Division of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

4 Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

5 Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.

6 Division of Gastroenterology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

7 Division of Gastroenterology, Department of Medicine, McGill University, Montreal, Quebec, Canada.

8 Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

9 Division of Gastroenterology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

10 Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center Los Angeles, California, USA.

Abstract

BACKGROUND: 3 classes of biologics are now available for the treatment of Crohn's disease. The availability of multiple treatment options has led to questions regarding the appropriateness of each agent for a given patient. We aimed to evaluate physician preferences for the use of specific biologic agents in a variety of Crohn's disease management scenarios using the RAND/UCLA Appropriateness Methodology.

RESULTS: Two hundred eighty-eight modifications of 3 clinical scenarios were rated. Factors that influenced biologic choice included perianal disease, antidrug antibody status, extraintestinal manifestations, consideration of potential pregnancy, and history of serious infection or malignancy. Anti-TNF therapy was considered appropriate in the postoperative patient. Ustekinumab and vedolizumab were considered appropriate in patients without perianal disease over the age of 65 with a history of malignancy or serious infection. The use of anti-TNF therapy was considered inappropriate in some scenarios whereby drug level was adequate and no antidrug antibody (ADA) was detectable.

CONCLUSIONS: We evaluated the appropriateness of the 3 available classes of biologics in a number of scenarios for the treatment of Crohn's disease. History of serious infection and malignancy, particularly in individuals over 65 years, and consideration of future pregnancy were patient-specific variables that impacted treatment decisions. These findings can serve as a guide for providers considering biologic therapy in patients with Crohn's disease.