Deprescribing 5-Aminosalicytes in Patients with Ulcerative Colitis on Concomitant Advanced Therapy: A Qualitative Analysis.

PURPOSE

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.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.