Gastroenterologists' Prescribing of Infliximab for Crohn's Disease: A National Survey

Background: Practice guidelines suggest that immunomodulators (IMs) be given prior to infliximab (IFX) in patients with Crohn's disease (CD). The package insert for IFX recommends that maintenance therapy be prescribed for patients who respond to induction therapy. Our aim was to determine the extent to which gastroenterologists (GIs) are utilizing IM prior to IFX and prescribing maintenance IFX when treating patients with CD. Methods: An 18-item questionnaire was developed and validated. The survey was sent to 4515 GIs who are members of the American Gastroenterology Association. Bivariate and multivariate analyses were performed. Results: In all, 305 GIs responded; 70% use an IM prior to IFX, 86% prescribe maintenance IFX, and 62% reported both use of IM prior to IFX and use of maintenance IFX. Academic GIs, Midwest GIs, and GIs prescribing IFX a few times per year were more likely to report both use of an IM prior to IFX and use of maintenance IFX (odds ratio [OR] = 4.56, 2.18, and 2.25, respectively). GIs demonstrated awareness of the risk of reactivation of tuberculosis when initiating IFX and appropriately manage infusion reactions. GIs were unable to rank serious adverse reactions associated with IFX. Conclusions: A total of 38% of GIs did not report the use of IM prior to IFX and/or did not use maintenance IFX. GIs practicing outside the Midwest and those in nonacademic settings may need additional training regarding prescribing IFX.