Motivation to pursue anti-TNFα treatment in patients with Crohn's disease - the SPACE motivation study.

Background: Crohn's disease (CD) is a chronic disorder requiring long-term treatment. However, up to 20% of patients interrupt temporarily or permanently anti-TNFα. Primary aim was to identify internal and external factors influencing patient's motivation to pursue anti-TNFα in active CD.
Methods: This was a French, multicentre, prospective study enrolling CD patients on anti-TNFα therapy since more than 3 months. Patients completed the Satisfaction of Patients with Crohn's Disease questionnaire (SPACE-Q) and other patient-reported-outcome tools at inclusion visit, and after 6 and 12 months.
Results: A total of 274 patients were included: 146 (53.3%) received adalimumab, while 128 (46.7%) infliximab. Most patients (78%) were still treated with anti-TNFα 12 months after enrolment. Patients' perception of necessity (p = 0.01) and concerns (p<0.0001) regarding medication, evaluated through the Belief about Medicines Questionnaire (BMQ), and expectation confirmation towards treatment convenience (p = 0.02), towards efficacy (p = 0.04), and treatment satisfaction (p = 0.03) according to SPACE-Q, correlated with motivation to pursue treatment. Patients with higher treatment satisfaction (p = 0.0004), stronger belief in treatment necessity (p<0.0001) and fewer concerns (p = 0.0002) were more likely to be very motivated.
Conclusion: Treatment satisfaction, treatment necessity, and concerns are correlated to motivation to pursue anti-TNFα. Specific questions focused on these patients' perceptions could help physicians to identify patients at risk of non-adherence and prevent therapy interruption.
Competing Interests: Declaration of Competing Interest F. D'Amico declares no conflict of interest. L. Peyrin-Biroulet has served as a speaker, consultant and advisory board member for Merck, Abbvie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Hospira/Pfizer, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, HAC- Pharma, Index Pharmaceuticals, Amgen, Sandoz, For- ward Pharma GmbH, Celgene, Biogen, Lycera, Samsung Bioepis, Theravance. L. Vandromme has served as consultant for Abbvie Laboratories. Y. Bounhik received consulting and lecture fees from AbbVie, Biogaran, Biogen, Boehringer Ingelheim, Celgene, Ferring, Gilead, Hospira, Janssen, Mayoli Spindler, MSD, Norgine, Pfizer, Roche, Samsung Bioepis, Sandoz, Sanofi, Shire, Takeda, UCB. P.Faure has served as consultant for Abbvie Laboratories. S. Nahon has served as consultant for Abbvie Laboratories. H. Hagège has served as consultant for Abbvie, Alfasigma, Ferring, Janssen, Norgine, Mayoly Spindler, MSD, Takeda, Tillotts. X. Hebuterne has served on advisory boards for Abbvie, Abivax, Alphasigma, ARARD, Arkopharma, Astellas, Baxter, Bristol Myers Squibb, Cellgen, Gilead, Eli Lilly, Enterome, Ferring, Fresenius-Kabi, InDex Pharmaceuticals, Janssen, MSD, Nutricia, Pfizer, Roche, Sanofi-Advantis, SAlix, Sangamo, Takeda, Theravance, Tillots. S. Benkhalifa is employee of Abbvie. M. Nachury has served as consultant for Abbvie, Adacyte, Amgen, Biogen, Ferring, Janssen, Mayoli-Spindler, MSD, and Takeda.
(Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)