对炎症性肠病患者实施抗肿瘤坏死因子治疗药物监测的态度、看法和障碍:一项来自中东的调查。

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
ACS Applied Electronic Materials Pub Date : 2024-02-24 eCollection Date: 2024-01-01 DOI:10.1177/17562848241230902
Gaurav B Nigam, Kelly Chatten, Ala Sharara, Talal Al-Taweel, Othman Alharbi, Hussein Elamin, Sameer Al Awadhi, Vito Annese, Jimmy K Limdi
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引用次数: 0

摘要

背景:越来越多的证据强调了治疗药物监测(TDM)对炎症性肠病(IBD)患者抗肿瘤坏死因子(TNF)疗法的疗效和成本效益的有利影响:我们调查了中东地区临床医生对 IBD TDM 的态度、看法和障碍:设计:通过五个中东国家(阿联酋、沙特阿拉伯、科威特、黎巴嫩和埃及)的国家胃肠病学会分发了一份包含 15 个问题的调查问卷:方法:收集临床医生的特征、人口统计学、使用模式以及与采用抗肿瘤坏死因子药物的 TDM 相关的障碍等方面的数据。结果:在 211 名受访者(82%)中,有 211 人使用了 TDM:在 211 名受访者(82% 为男性)中,82% 是顾问,8% 是对胃肠病学(GI)感兴趣的医生,6% 是胃肠病学实习生。其中,152 人符合纳入标准,每月治疗的 IBD 患者超过 5 人,每月使用抗肿瘤坏死因子的患者⩾1 人。78%(95% CI:71-85)的受访者在临床实践中使用了 TDM。93%的受访者在出现应答丧失 (LOR) 后使用了 TDM,40%的受访者在出现原发性无应答 (PNR) 时使用了 TDM,33%的受访者在停药后重新开始抗肿瘤坏死因子治疗前使用了 TDM,34%的受访者主动使用了 TDM。没有特定因素与使用 TDM 相关。使用 TDM 的障碍包括成本(85%)、结果滞后(71%)和缺乏保险报销(65%)。对 TDM 的总体了解(70%)、对结果的解释和行动(76%)或对临床指南的认识(57%)均未被视为障碍。如果障碍得以消除,95% 的人会更频繁地使用 TDM;93% 的人会使用 LOR,60% 的人会使用 PNR,50% 的人会在停药后重新开始使用,54% 的人会主动使用 TDM:结论:大多数胃肠病学家在 LOR 中使用 TDM,但成本、时间滞后和保险报销是主要障碍。解决这些障碍将提高反应性和主动性 TDM 的合理使用率,从而优化 IBD 的抗肿瘤坏死因子治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Attitudes, perceptions and barriers in implementing therapeutic drug monitoring for anti-TNFs in inflammatory bowel disease: a survey from the Middle East.

Background: A growing body of evidence underscores the beneficial impact of therapeutic drug monitoring (TDM) on the efficacy and cost-effectiveness of anti-tumour necrosis factor (TNF) therapy in patients with inflammatory bowel disease (IBD).

Objectives: We surveyed clinician attitudes, perceptions and barriers related to TDM in IBD in the Middle East.

Design: A 15-question survey was distributed through national gastroenterological societies in five Middle Eastern countries (UAE, Saudi Arabia, Kuwait, Lebanon and Egypt).

Methods: Data on clinician characteristics, demographics, utilization patterns and obstacles related to the adoption of TDM with anti-TNFs were gathered. Logistic regression analysis was used to predict factors influencing the utilization of TDM.

Results: Among 211 respondents (82% male), 82% were consultants, 8% were physicians with an interest in gastroenterology (GI), and 6% were GI trainees. Of these, 152 met inclusion criteria, treating >5 IBD patients per month and ⩾1 with an anti-TNF per month. TDM was used in clinical practice by 78% (95% CI: 71-85) of respondents. TDM was utilized following the loss of response (LOR) in 93%, for primary non-response (PNR) in 40% and before restarting anti-TNF therapy after a drug holiday in 33% of respondents, while 34% used TDM proactively. No specific factors were associated with the use of TDM. Barriers to TDM use included cost (85%), time lag to results (71%) and lack of insurance reimbursement (65%). Overall knowledge of TDM (70%), interpretation and actioning of results (76%) or awareness of clinical guidelines (57%) were not perceived as barriers. If barriers were removed, 95% would use TDM more frequently; 93% for LOR, 60% for PNR, 50% when restarting after a drug holiday, and 54% would use TDM proactively.

Conclusion: Most gastroenterologists use TDM for LOR, with cost, time lag and insurance reimbursement being significant barriers. Addressing these barriers would increase the judicious use of reactive and proactive TDM to optimize anti-TNF therapy in IBD.

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