Patterns of conventional therapy use and advanced therapy initiation drivers in inflammatory bowel disease

Background: Accumulating evidence and conditional regional guidelines support early initiation of advanced therapy (AT) in Crohn's disease (CD) and ulcerative colitis (UC). Nonetheless, AT utilization in real-world clinical practice remains limited. Objectives: The aim of this study was to assess barriers for AT initiation among surveyed gastroenterologists. Design: Quantitative survey with a multimodal approach. Methods: In total, 142 gastroenterologists (30 each from Germany, Italy, and the United Kingdom; 52 from the United States) were surveyed from June to November 2023 to capture drivers of AT initiation. They were classified as low or high conventional therapy (CT) cyclers (using 0-1 or ⩾2 CT cycles before initiating AT, respectively). Behavioral analysis was performed employing a COM-B (Capability, Opportunity, Motivation, Behavior) model. Results: Across countries, 67.3%-90.0% of surveyed gastroenterologists agreed that AT initiation should be early enough to modify the trajectory of disease. Nonetheless, the majority (51.9%-80.0%) of surveyed gastroenterologists were high CT cyclers (except those in the United States treating CD (36.5%)). When surveyed about the importance of factors for initiating AT in patients with UC, high cyclers placed greater importance on treatment familiarity (+8.1%) than low cyclers and preferred to exhaust other treatment options first (+8.9%). Alternatively, low cyclers placed more importance on patient preference (+15.7%) and peer recommendations (+12.9%) than high cyclers. There were fewer differences in AT prescription drivers between low and high CT cyclers for CD than UC. Conclusion: High CT cyclers placed an overall lower value on AT, suggesting clinical beliefs played a determining role in AT initiation among surveyed gastroenterologists.