title: Addressing current treatment challenges in Crohn's disease in real life: a physician's survey.
abstract: BACKGROUND
  In recent years several trials have addressed treatment challenges in Crohn's disease. Clinical trials however, represent a very special situation.
  
  
  OBJECTIVE
  To perform a cross-sectional survey among gastroenterologists on the current clinical real life therapeutic approach focussing on the use of biologics.
  
  
  METHODS
  A survey including six main questions on clinical management of loss of response, diagnostic evaluation prior to major treatment changes, preference for anti-tumour necrosis factor (TNF) agent, (de-)escalation strategies as well as a basic section regarding personal information was sent by mail to all gastroenterologists in Switzerland (n=318).
  
  
  RESULTS
  In total, 120 questionnaires were analysed (response rate 37.7%). 90% of gastroenterologists in Switzerland use a thiopurine as the first step-up strategy (anti-TNF alone 7.5%, combination 2.5%). To address loss of response, most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the biologic and adding a thiopurine. In case of prolonged remission on combination therapy, the thiopurine is stopped first (52.6%) after a mean treatment duration of 15.7 months (biologic first in 41.4%).
  
  
  CONCLUSIONS
  Everyday clinical practice in Crohn's disease patients appears to be incongruent with clinical data derived from major trials. Studies investigating reasons underlying these discrepancies are of need to optimize and harmonize treatment.
authors.affiliation: Division of Gastroenterology & Hepatology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
authors.affiliation: Division of Gastroenterology & Hepatology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Sanja
authors.initials: S
authors.lastname: Radivojevic
authors.affiliation: Division of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christine N
authors.initials: CN
authors.lastname: Manser
authors.affiliation: Division of Gastroenterology & Hepatology, Seespital Horgen, Horgen, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Frei
authors.affiliation: Division of Gastroenterology & Hepatology, Medical University Hospital Liestal, Liestal, Switzerland.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Burri
authors.affiliation: Division of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.affiliation: Division of Gastroenterology & Hepatology, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Schoepfer
authors.affiliation: Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy-Brabois, Vandoeuvre-lès-Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.affiliation: Clinic de la source, Gastroenterology, Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Michetti
authors.affiliation: Division of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.affiliation: Division of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland. Electronic address: luc.biedermann@usz.ch.
authors.forename: Luc
authors.initials: L
authors.lastname: Biedermann
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D005762:Gastroenterology; D019538:Health Care Surveys; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy / Q000379:methods*; D060046:Maintenance Chemotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011687:Purines / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013557:Switzerland; D013872:Thionucleosides / Q000627:therapeutic use; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011687:Purines; D013872:Thionucleosides; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF agent; Crohn's disease; Loss of response; Step-up strategy; Thiopurine; Treatment de-escalation