Intest Res.  2022 Apr;20(2):213-223. 10.5217/ir.2021.00031.

Drug therapy and monitoring for inflammatory bowel disease: a multinational questionnaire investigation in Asia

• Cai C
• Lu J
• Lai L
• Song D
• Shen J
• Tong J
• Zheng Q
• Wu K
• Qian J
• Ran Z

• KMID: 2529567
• DOI: http://doi.org/10.5217/ir.2021.00031

Abstract

Background/Aims
The incidence and prevalence of inflammatory bowel disease (IBD) is rising in Asia recently. The study aimed to obtain a comprehensive understanding of the current status of drug therapy and monitoring for IBD in Asia.
Methods
A questionnaire investigation on drug therapy and monitoring for IBD was conducted right before the 6th Annual Meeting of Asian Organization for Crohn’s & Colitis. Questionnaires were provided to Asian physicians to fill out via emails between March and May 2018.
Results
In total, responses of 166 physicians from 129 medical centers were included for analysis. Among the surveyed regions, the most average number of IBD specialist gastroenterologists and nurses was 4.8 per center in Taiwan and 2.5 per center in Mainland China, respectively. 5-Aminosalicylic acid/sulfasalazine (99.4%) was the most preferred first-line choice for mild-moderate ulcerative colitis (UC), meanwhile corticosteroid (83.7%) was widely applied for severe UC. The first-line medication for Crohn’s disease (CD) markedly varied as corticosteroid (68.1%) was the most favored in Mainland China, Japan, and South Korea, followed by infliximab (52.4%) and azathioprine (47.0%). Step-up strategy was preferred in mild-moderate UC (96.4%), while 51.8% of the physicians selected top-down treatment for CD. Only 25.9% and 17.5% of the physicians could test blood concentration of infliximab and antibody to infliximab in their hospitals, respectively.
Conclusions
The current status of drug therapy and monitoring for IBD in Asia possesses commonalities as well as differences. Asian recommendations, IBD specialist teams and practice of therapeutic drug monitoring are required to improve IBD management in Asia.

Keyword

Inflammatory bowel disease; Questionnaire; Asia; Drug therapy and monitoring

Figure

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  Fig. 1. First-line choice selected for mild-moderate ulcerative colitis (UC) (A), severe UC (B), and Crohn’s disease (C). 5-ASA, 5-aminosalicylic acid; SASP, sulfasalazine; AZA, azathioprine; IFX, infliximab; CsA, cyclosporin A; ADA, adalimumab; 6-MP, 6-mercaptopurine.

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  Fig. 2. Treatment strategy selected for mild-moderate ulcerative colitis (UC) (A), severe UC (B), and Crohn’s disease (C). Right-side figures are the general data from all the surveyed areas.

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  Fig. 3. Frequency for monitoring adverse events of 5-aminosalicylic acid (5-ASA)/sulfasalazine (SASP) (A), corticosteroid (B), immunomodulator (C), and biological agent (D).

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  Fig. 4. Available biomarkers tested in the respondents’ working hospitals (A), concomitant infection rate in patients with immunomodulatory or/and biologics (B), and lymphoma population after inflammatory bowel disease (C). TNF-α, tumor necrosis factor α; ATI, antibody to infliximab; IFX, infliximab; CsA, cyclosporin A; 6-MP, 6-mercaptopurine.

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