What do UC Patients want in a Medication?
In a report published in the journal, Inflammatory Bowel Diseases, based on an American internet survey, and a subsequent similar Canadian survey, ulcerative colitis patient voices are clear – they want fast symptom relief from their medication above all else.
Patients in the US survey described their ideal therapy as one that was highly effective (97%) with minimal side effects (74%) and they prefer convenient home administration in an oral formulation, and wished to avoid both injections and rectal applications. About a quarter of patients reported that low cost, fewer pills, less frequent dosing, and taking medication at meal times were also important considerations.
The Canadian survey looked at this in a different way, it asked participants to prioritize their preferred medication attributes in one category over another. Results revealed that patients preferred ‘speed to symptom relief’ 94% of the time over number of pills per dose and 90% of the time over once daily dosing.
Results from both analyses show that patients may be responsible for not getting the full relief possible. While 35% of the 1,595 respondents to the US survey said they always took their medication as prescribed, there were several reasons the study mentions for why more than 60% of patients admitted that they did not take their medication appropriately, including:
- too many pills,
- too frequent intervals for dosing,
- medication was too inconvenient,
- for those using rectal applications, a dislike of this delivery method,
- they were not experiencing symptoms, and
- the majority (90%) of 944 noncompliant patients said that they simply forget to take every dose as prescribed.
Ulcerative colitis affects patients’ lives in significant ways. Patients in the US study said they made the following kinds of changes due to the disease:
- spending more time at home (46%),
- participating in fewer social activities (37%),
- eating at restaurants less frequently (31%),
- adjusting work life (36%), and
- reducing exercise (25%).
More than half of respondents in the Canadian survey see a gastroenterologist to manage their ulcerative colitis, while about 30% see a general practitioner. Aside from their physician, conducting an internet search is the number one way patients get information about their condition (47%), followed by visiting a medication website (30%), and consulting a pharmacist (24%). However, respondents trust the information from their physician to a much greater degree than from any other source.
Interestingly, about 40% of respondents say their employer knows about their ulcerative colitis, and 15% believe they lost their job because of their condition, while 18% gave up employment “voluntarily” because of it.
Overall, ulcerative colitis negatively influences patients’ quality of life. Mostly, what they want is a medication that prevents flare-up, relieves rectal bleeding, provides fast relief, provides consistent relief, reduces abdominal pain, prevents diarrhea, reduces the frequency of bowel movements, and works as expected.
First published in the Inside Tract® newsletter issue 165 – January/February 2008
1. Loftus EV. A practical perspective on ulcerative colitis: patients’ needs from aminosalicylate therapies. Inflammatory Bowel Diseases. 2006;12:1107-1113.
2. A survey of 100 Canadian patients conducted by TNS Healthcare, Inc. and sponsored by Procter & Gamble Pharmaceuticals Canada, 2007.
Safe and Effective Medicine
Anyone affected by ulcerative colitis (UC) knows the importance of working closely with your physician to find the right treatment regimen and, since no two patients have an identical experience with this disease, it can be a challenging process.
A new Canadian study1 published in the journal, Alimentary Pharmacology and Therapeutics, examining patient needs in the management of UC, identifies what patients want most from a medication. This study surveyed 100 Canadian UC patients, asking them to identify from among 20 different medication attributes, the ones they felt were most important. Those characteristics rated most highly were linked to medication efficacy (e.g. provides consistent relief, relieves rectal flare-ups, prevents UC flare, reduces abdominal pain, provides fast relief, and trust that it will work as promised) and safety (few side effects). When asked to compare selected attributes directly, speed to symptom relief and few side effects were the most important features in considering a medication. In fact, 84% of patients cited speed to symptom relief and 75% selected few side effects as preferred aspects. Considerations such as dosing regimen (frequency, number of pills), cost, and formulary coverage ranked as less important.
The researchers also asked patients for their input on a number of other topics including their satisfaction with physician care and the types of resources they consulted for medical information.
With regard to their management regime, the survey asked patients to rate their satisfaction with their ulcerative colitis care. Encouragingly, nearly 80% of patients expressed satisfaction with their physician’s care, 73% believed their medication was safe for long-term use, and 67% had adequate knowledge about their illness. Only 11% of those surveyed were interested in changing their current medication regime.
Most of those participating in this study named their gastroenterologist as their primary source information about ulcerative colitis, followed by their family doctor, various online sources, their pharmacist, and family and/or friends. The study notes that, due to the high proportion of participants with post-secondary education, and the fact that this survey was internet-based, these numbers may not reflect all UC patients, particularly those with less education, who tend not to access the internet as much.
“These findings are valuable for those who are treating UC patients, as they confirm what patients are looking for in terms of treatments,” said the study’s lead author, Dr. James Gray, Clinical Assistant Professor of Gastroenterology, University of British Columbia. “This being said, each patient is different, so it’s important for healthcare professionals to work closely with every patient, to find the right individualized strategy and treatment plan.”
Patients and Physicians Need to Work Together
A recent survey of 61 Canadian gastroenterologists2 found that speed to symptom relief (84%) and few side effects (63%) are also the most important characteristics physicians look for when prescribing medication for ulcerative colitis patients. Physicians (more than half) were more concerned than were patients (about one-third) regarding cost and formulary coverage when prescribing drugs for their patients. Interestingly, neither patients (35%) nor physicians (32%) cited a strong preference toward once-daily dosing, suggesting that perhaps “patients in this particular disease state do not necessarily perceive pill burden as the main factor in convenience.” A newer dosing formulation of mesalamine, Asacol 800, provides combined faster relief of rectal bleeding and reduction in stool frequency, compared with Asacol (400mg), in addition to the added convenience of taking 50% fewer pills every day.3
“Once a patient finds something that works well for them, there may be reluctance to switch to a different treatment,” said Dr. Gray. “However, it is important for physicians to maintain an ongoing dialogue with their patients to determine the best management plan. Fresh information is always emerging and we should take advantage of any new knowledge that could benefit our patients.”