Cruchelow Katie R, Bonnet Kemberlee R, Zuckerman Autumn D, Schlundt David G, Horst Sara N
Vanderbilt Specialty Pharmacy, Vanderbilt Health System, Nashville, TN, USA.
Department of Psychology, Vanderbilt University, Nashville, TN, USA.
Patient Prefer Adherence. 2025 May 8;19:1351-1364. doi: 10.2147/PPA.S501049. eCollection 2025.
Data suggests 5-Aminosalicytes (5-ASA) medication does not influence outcomes in patients with moderate to severe ulcerative colitis (UC) on advanced therapy and can be discontinued. However, patients' perspectives on discontinuing UC-related medications have not been evaluated and should be incorporated when considering therapy changes. This study explored patients' experiences with UC treatment (5-ASA) in combination with advanced therapy, and barriers, facilitators, and attitudes toward deprescribing 5-ASAs.
To qualitatively evaluate patients' views on 5-ASA medication discontinuation two focus groups were conducted for patients with UC on stable doses of 5-ASA medication and advanced therapy for at least 6 months. Patients were asked about their satisfaction with and barriers to current therapy, quality of life, and opinions about the potential medication deprescribing. Transcripts were analyzed using an iterative inductive/deductive approach.
Ten patients participated with an average age 50 years (SD ± 11 years), 50% Female, and 80% White. Advanced therapy included tofacitinib (20%), vedolizumab (20%), or infliximab (20%). Qualitative analysis identified patient and clinician factors in the deprescribing process. Patient themes included emotions and coping, quality of life, attitudes and beliefs, experiences with the condition, and symptoms. Participants identify clinician themes including endorsement, communication, patient relationship, information distribution, and deprescribing readiness for change. The shared patient/clinician risk assessment was vital to moving towards deprescribing, however the decision to deprescribe was influenced by barriers and facilitators including further discussion with their clinician.
Patients with UC on advanced therapy and 5-ASA are open to deprescribing their 5-ASA but would have questions for their prescribing clinician including assurance of continued symptom management or ease of returning to the 5-ASA if needed.
数据表明，对于接受进阶治疗的中重度溃疡性结肠炎（UC）患者，5-氨基水杨酸（5-ASA）药物治疗不会影响治疗结果，且可以停用。然而，尚未评估患者对停用UC相关药物的看法，在考虑治疗方案变更时应纳入这一因素。本研究探讨了患者在接受UC治疗（5-ASA）联合进阶治疗时的经历，以及停用5-ASA的障碍、促进因素和态度。
为了定性评估患者对停用5-ASA药物的看法，针对服用稳定剂量5-ASA药物并接受进阶治疗至少6个月的UC患者进行了两个焦点小组访谈。询问患者对当前治疗的满意度和障碍、生活质量以及对潜在药物停用的看法。使用迭代归纳/演绎方法对访谈记录进行分析。
10名患者参与，平均年龄50岁（标准差±11岁），50%为女性，80%为白人。进阶治疗包括托法替布（20%）、维多珠单抗（20%）或英夫利昔单抗（20%）。定性分析确定了停药过程中的患者和临床医生因素。患者主题包括情绪与应对方式质量、生活质量、态度与信念、病情经历和症状。参与者确定的临床医生主题包括认可、沟通、医患关系、信息传播以及对改变停药的准备情况。患者/临床医生共同的风险评估对于推进停药至关重要，然而，停药的决定受到障碍和促进因素的影响，包括与临床医生的进一步讨论。
接受进阶治疗并服用5-ASA的UC患者愿意停用5-ASA，但会向开处方的临床医生提出问题，包括确保症状持续得到管理，或在需要时能否轻松恢复使用5-ASA。
