Lack of Biosimilar Knowledge for IBD Ranks Among Providers' Main Concerns

Providers of care for patients with inflammatory bowel disease (IBD) feel that lack of knowledge of biosimilars is one of their top therapy-related concerns, according a survey designed to identify educational needs and differences among clinicians working with patients with IBD.

Among clinicians working with patients with IBD, the lowest percentage of comfort with therapeutic decision making involves use of Janus kinase (JAK) inhibitors (29%, including managing adverse events), drug holidays (25%), and biosimilars (24%), according to the survey, which was sponsored by the Crohn's & Colitis Foundation.

“Our survey suggests that the existing [educational] resources may not adequately reach clinicians in need,” the authors wrote. Just 1% of practitioners incorporate clinical trial option discussion or referral as a regular part of their practice, according to the findings.

The survey (n = 220) had a response rate of 3% and included 122 providers. Others included in the survey were advance practice nurses, registered nurses, and physician assistants.

With regard to managing patients’ pain medication needs, 62% reported discomfort prescribing medical cannabis (if legally available), and 21% expressed lack of comfort in addressing overall pain management. Medical cannabis is one way to avoid prescribing opioids, which have high rates of morbidity and mortality in patients with IBD.

Fifteen percent said they were not comfortable assessing psychological needs or making referrals to mental health specialists.

The survey suggested substantial knowledge gaps exist in multiple aspects of disease management for healthcare providers who treat inflammatory bowel disease (IBD).

Authors of the survey said respondents tended to prefer live learning opportunities, such as conferences, as the best way to bridge these gaps. Survey results showed that 65% of respondents preferred live education versus on-demand, web-based materials (27%) or scientific journals (8%).

Sixty-nine percent said they would benefit from opportunities for continuing medical education credit.

“The results of this study will help guide the Crohn’s & Colitis Foundation and other organizations in the development of educational materials and/or programs for professionals,” the authors wrote.

The greatest levels of discomfort in managing care for special populations of patients with IBD was identified for those with prior malignancy (35%), patients who are pregnant or interested in family planning (33%), and the elderly (30%).

Respondents reported high levels of comfort treating patients with anti-tumor necrosis factor (anti-TNF) therapy (82%), using immunomodulators (79%), and deciding between combination and monotherapy (77%).

Survey results also suggested knowledge gaps between categories of healthcare professionals. Compared with physicians, advance practice providers (APPs) and registered nurses were “significantly” less comfortable recommending diagnostic testing or making an IBD diagnosis (96% vs 79%), assessing phenotype and severity (91% vs 71%), and managing perianal CD treatment (83% vs 63%).

Compared with adult providers, pediatric providers were less comfortable recommending biosimilars (61% vs 36%), JAK-inhibitors (59% vs 14%), IL-12/23 inhibitors (76% vs 46%) or drug holidays (67% vs 21%).

“With a rapidly changing treatment landscape and an increase in the diversity of providers delivering care, additional opportunities to keep abreast of practice changes are critical to providing comprehensive, quality care in IBD,” the authors wrote.

Respondents reported relatively high levels of comfort in knowing when to refer to dieticians (81%), addressing nutritional deficiencies (72%), and making dietary recommendations (72%). Meanwhile, 60% reported comfort appealing insurance decisions or helping patients navigate insurance issues.

More than 50% of respondents said they don’t participate in shared decision making with patients. The most common limiting factors cited were lack of time (43%) and health literacy (31%).

Reference

Malter L, Jain A, Cohen BL, et al. Identifying IBD providers' knowledge gaps using a prospective web-based survey [published online February 26, 2020]. Inflamm Bowel Dis. doi: 10.1093/ibd/izaa032.