title: Practice patterns in the use of anti-tumor necrosis factor alpha agents in the management of Crohn's disease: a US national practice survey comparing experts and non-experts.
abstract: BACKGROUND
  The US Food and Drug Administration currently approves three types of anti-tumor necrosis factor α (anti-TNFα) therapy for treatment of moderate to severe Crohn's disease. There are no guidelines to clarify which of the drugs may be better suited to individual clinical scenarios.
  
  
  OBJECTIVE
  We gathered national data on the prescribing pattern, comfort levels, and algorithms gastroenterologists use for management of their biologic-requiring Crohn's disease patients.
  
  
  METHODS
  An internet survey was mailed to members of the American Gastroenterology Association. Responses were separated into "non-expert" and "expert" physician groups on the basis of whether a practice consisted of >50% of patients with inflammatory bowel disease. We compared experts with non-experts with regard to the use of the three anti-TNF agents, attitudes regarding their relative efficacy, and their experience with adverse events.
  
  
  RESULTS
  Of 3,990 eligible gastroenterologists, 473 replied in full (11.9%). Sixty (12.6%) respondents met the criterion for IBD expert physician. Experts were comfortable using both immunomodulators and anti-TNFα therapy. Community physicians were equally comfortable prescribing 6-mercaptopurine, azathioprine, infliximab, and adalimumab, but less comfortable than experts with methotrexate (56 vs. 86%, P<0.05) and certolizumab (68 vs. 89%, P<0.05). Expert physicians were much more likely to have encountered adverse reactions to anti-TNFα therapy.
  
  
  CONCLUSIONS
  Our results suggest that experts are more comfortable using a broader array of medical therapy than non-expert physicians. Although both groups had similar concerns regarding side-effects of anti-TNFα therapy, expert physicians were much more likely to have managed a broad range of complications in their patient population.
authors.affiliation: Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, 622 West 168th Street, PH 20-303, New York, NY 10032, USA. As3576@columbia.edu
authors.forename: Arun
authors.initials: A
authors.lastname: Swaminath
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Capiak
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Present
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D002986:Clinical Trials as Topic; D003424:Crohn Disease / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use; D019538:Health Care Surveys; D006801:Humans; D000069285:Infliximab; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D008727:Methotrexate