Current Practice of Anti-TNF-α Treatment in Inflammatory Bowel Disease: Results From A National Survey in Sweden

AIM: To assess current practice of anti-TNF-α treatment in inflammatory bowel disease among Swedish gastroenterologists. Methods: A web-based questionnaire consisting of 26 multiple-choice questions was sent to 272 gastroenterologists in adult practice. Results: Of the 112 gastroenterologists (41%) that responded, all 102 in inflammatory bowel disease practice used anti-TNF-α. Almost all (97%) used combination therapy with immunomodulators and three quarters (73%) used both thiopurines and methotrexate as immunomodulators. The dominant treatment strategy was the “rapid step up” model, favored by 67%. Two thirds continued with combination therapy for more than 6 months and 80% had actively discontinued anti-TNF-α treatment in patients with longstanding remission. Two thirds (61%) had experience of anti-TNF-α during pregnancy and breast-feeding. The dominant strategy, advocated by 91%, was to continue treatment during the first two trimesters, and, if necessary, resume after delivery. All gastroenterologists screened for tuberculosis, 88% for hepatitis B and C, but only 33% vaccinated regularly against varicella zoster and MPR. Discussion: Respondents from university hospitals were more likely to discontinue anti-TNF-α treatment (91% vs 70%, P=0.01), use rapid infliximab infusions (24% vs 7%, P=0.004), and use IGRA testing in tuberculosis screening (88% vs 71%, P=0.04). They were also less likely to use single infliximab infusions as rescue therapy for ulcerative colitis (14% vs 33%, P=0.05). Conclusions: Recent advances in anti-TNF-α treatment of inflammatory bowel disease seem to have been adapted to a large extent by Swedish gastroenterologists. Minor differences in clinical practice were observed between university-based and other gastroenterologists.