Introduction
Fatigue is a prevalent and debilitating symptom among patients with Crohn’s disease (CD) or ulcerative colitis (UC). However, due to its subjective nature and the lack of effective management strategies in CD/UC, fatigue often goes under-recognized and under-treated.1 The Communicating Needs and Features of IBD Experiences (CONFIDE) study explored patient and healthcare professional (HCP) perspectives on the experiences and impact of CD/UC-related symptoms in Europe (France, Germany, Italy, Spain, and UK), the United States (US) and Japan.
Aims & Methods
Online, quantitative, cross-sectional surveys were conducted separately among patients with moderate-to-severe CD/UC and HCPs who make prescribing decisions for patients. Moderate-to-severe CD/UC were defined using criteria based on previous treatment, steroid use, and/or hospitalization. Descriptive statistics were used here to summarize the European and US data related to fatigue.
Results
A total of 547 European (55.4% male, mean age: 38.0 years) and 215 US (54.9% male, 40.9 years) patients with CD and 556 European (57.4% male, 38.9 years) and 200 US (61.5% male, 40.4 years) patients with UC completed the surveys. The proportions of patients who received advanced therapies at the time of survey completion were 63.4% and 58.1% among European and US patients with CD. Among patients with UC, the percentages were 54.1% and 76.5% of European and US patients.
Overall, 34.2% European and 35.8% US patients with CD, and 20.9% European and 27.5% US patients with UC reported currently experiencing fatigue (in the past month). Similar results were observed among patients receiving advanced therapies: CD (Europe: 34.3%; US: 36.0%); UC (Europe: 19.9%; US: 25.5%). Fatigue was ranked among the top five symptoms with greatest impact on patients by 44.5% European and 52.9% US patients with CD, and 55.2% European and 37.5% US patients with UC. Among patients who reported currently experiencing fatigue, 29.9% European and 36.4% US patients with CD, and 22.4% European and 40.0% US patients with UC discussed it with their HCPs at every appointment. Among patients who did not discuss fatigue with their HCPs at every appointment, at least two-thirds indicated that they would like to discuss it more frequently: CD (Europe: 75.6%; US: 67.3%); UC (Europe: 74.4%; US: 66.7%).
Surveys were completed by 503 European (70.8% male) and 200 US (78.0% male) HCPs, of which 92.5% were gastroenterologists/internal medicine practitioners. A minority of HCPs reported fatigue among the top five symptoms with the greatest impact on patients: CD (Europe: 33.9%; US: 22.0%); UC (Europe: 22.7%; US: 11.5%). More than half of HCPs reported proactively discussing fatigue at a routine appointment with patients: CD (Europe: 69.4%, US: 59.5%); UC (Europe: 64.6%, US: 59.0%). Among HCPs not proactively discussing fatigue, the most common reason was that they expected patients to bring it up if it is an issue: CD (Europe: 39.0%, US: 30.9%); UC (Europe: 37.1%, US: 32.9%).
Conclusion
For both patients with CD/UC, fatigue was a common and impactful symptom, despite the use of advanced therapies. A substantial proportion of patients experiencing fatigue who did not discuss it at every HCP appointment, reported a desire to discuss fatigue more frequently. Although more than half of HCPs reported proactive discussion of fatigue with their patients, some HCPs expected patients to bring it up. This indicates a communication gap between patients and HCPs and highlights the underappreciation of the impact of fatigue in CD/UC.
References
1. Farrell D, et al. (2020) Cochrane Database Syst Rev. 4(4), CD012005.
Disclosure
Remo Panaccione, Consultant for: Abbott, AbbVie, Abbivax, Alimentiv (formerly Robarts), Amgen, AnaptysBio, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, Eli Lilly, Ferring, Galapagos, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pendopharm, Pfizer, Progenity, Prometheus Biosciences, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Spyre Therapeutics, Takeda Pharmaceuticals, Theravance Biopharma, Trellus, Union Biopharma, Viatris, Ventyx, UCB; Speaker’s Fees for: AbbVie, Amgen, Arena Pharmaceuticals, Bristol-Myers Squibb, Celgene, Eli Lilly, Ferring, Fresenius Kabi, Gilead Sciences, Janssen, Merck, Organon, Pfizer, Roche, Sandoz, Shire, Takeda Pharmaceuticals; Advisory Boards for: AbbVie, Alimentiv (formerly Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Ferring, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pfizer, Progenity, Protagonist Therapeutics, Roche, SandozShire, Sublimity Therapeutics, Takeda Pharmaceuticals, Ventyx.
Stefan Schreiber, Consultancy fees: AbbVie, Arena, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Falk, Fresenius, Gilead Sciences, IMAB, Janssen, Eli Lilly and Company, Hikma, MSD, Mylan, Pfizer Inc, Protagonist, Provention Bio, Takeda, Ventyx, and Theravance.
Simon Travis, Grants: AbbVie, ECCO, Eli Lilly and Company, Helmsley Trust International, International Organization for the Study of Inflammatory Bowel Disease, Norman Collision Foundation, Pfizer, Takeda, UCB Pharma, UKIERI, Vifor Pharma; Honoraria: Ferring Pharmaceuticals, Takeda, Eli Lilly and Company, Bristol Myers Squibb, Janssen, Violicom; Travel grants: AbbVie, Eli Lilly and Company, Janssen, Pfizer, Takeda, Ferring Pharmaceuticals, Amgen, Biogen; Consultancy fees: AbbVie, Allergan, Amgen, Apexian, Bioclinica, Biogen, Bristol Myers Squibb, ChemoCentryx, Cosmo Pharmaceuticals, Endpoint Health, Eli Lilly and Company, Enterome, Equillium, Ferring Pharmaceuticals, Genentech/Roche, GlaxoSmithKline, Immunocore, Immunometabolism, Janssen, Merck, Merck Sharp & Dohme, Mestag Therapeutics, Novartis, Pfizer, Protagonist Therapeutics, Proximagen, Receptos, Roche, Sanofi, Satisfai Health, Sensyne Health, Sorriso Pharmaceuticals, Takeda, UCB Pharma, VHsquared, Vifor Pharma.
Marla C. Dubinsky, Consultancy fees: AbbVie, Abivax, Astra Zeneca, Boehringer Ingelheim International GmbH, Bristol Myers Squibb, Celgene Corporation, Eli Lilly and Company, F. Hoffman-La Roche Ltd, Genentech Inc., Gilead Sciences, Janssen, LLC, Merck, Pfizer, Prometheus Biosciences, Takeda Pharmaceuticals USA, Inc., and UCB; Stock options: TrellusHealth Inc.; Research support: AbbVie, Janssen, LLC, Pfizer, and Prometheus Labsa; and licensing fees: Takeda.
Toshifumi Hibi, Personal fees: Abbvie GK, EA Pharma, Janssen Pharmaceutical K.K, JIMRO, Mitsubishi-Tanabe, Mochida Pharmaceutical, Pfizer Japan, Sandoz K.K, Takeda Pharmaceutical, Zeria Pharmaceutical, Celltrion Healthcare Japan, Eli Lilly Japan, Gilead Sciences, Miyarisan Pharmaceutical, Alfresa Pharma Corporation, Kyorin Pharmaceutical; Grants: JIMRO, Mochida Pharmaceutical, Zeria Pharmaceutical, Miyarisan Pharmaceutical, Alfresa Pharma Corporation, and Kyorin Pharmaceutical.
Christian Atkinson, Employment: Adelphi Real World.
David Rubin, Grant support: Takeda; Consultant: Abbvie, Altrubio, Apex, Avalo Therapeutics, Bristol-Myers Squibb, Buhlmann Diagnostics Corp, Celgene, Connect BioPharma, Intouch Group, Iterative Health, Janssen Pharmaceuticals, Lilly, Pfizer, Samsung Neurologica, and Takeda. Board of Trustees: Crohn’s & Colitis Foundation; Board of Directors: Cornerstones Health.
Alison Potts Bleakman, Theresa Hunter Gibble, Tommaso Panni, Cem Kayhan, Eoin J. Flynn, and Angelo D. Favia are employees and stockholders of Eli Lilly and Company.