DigiCon

With which of the following statements regarding inflammatory bowel disease (IBD) phenotype in India you agree the most? (Multiple options can be selected) *

Mild to moderate IBD is more prevalent

Moderate to severe IBD is more prevalent

Patient age at the diagnosis of Crohn’s disease (CD) is a decade earlier than that of Ulcerative colitis (UC)

Patient age at the diagnosis of Ulcerative colitis (UC) is a decade earlier than that of Crohn’s disease (CD)

Patient age at the time of diagnosis of UC and CD is closer to 40 years

What is your clinical experience about prevalence of IBD in young patients? *

UC occurs at a younger age

CD occurs at younger age

UC and CD occur at younger age

Others

According to you which statement is true for gender distribution for patients of IBD in your practice? (Multiple options can be selected) *

Females are predominantly affected with CD than UC

Females are predominantly affected with UC than CD

Males are predominantly affected with CD than UC

Males are predominantly affected with UC than CD

No significant gender difference for UC and CD

Which of the following type of ulcerative colitis is predominantly seen in your practice? *

Pancolitis

Left sided colitis

Proctitis

Others

Which part of gastrointestinal tract is commonly affected by CD in most of your patients? (Multiple options can be selected) *

Proximal small intestine

Terminal ileum

Ileocolonic

Colon

Perianal

Any other

What is the commonly observed disease behaviour of IBD patients in your practice? (Multiple options can be selected) *

Chronic active course

Relapsing remitting course

Prolonged remission with treatment

Subsequent shortening of period of remission

Aggressive progression requiring surgery

Others

Which statement/s about extraintestinal manifestations (EIM) of IBD is/are true in your practice? (Multiple options can be selected) *

At least one EIM is common in majority of patients

Multiple EIMs are common in majority of patients

EIMs are common in UC

EIMs are common in CD

Female gender, severe disease and use of steroids are associated with EIM

Others

Which organ system is most commonly affected in EIM in IBD as per your clinical experience?*

Musculoskeletal system

Ocular system

Cutaneous system

Cardiovascular system

Pulmonary system

Any other

What is/are the preferred test/s in your practice to diagnose IBD? (Multiple options can be selected) *

Colonoscopy/Sigmoidoscopy

Inflammatory markers like ESR/CRP

Fecal calprotectin

Serum albumin

Intestinal ultrasound

Histopathology

Any Others

What is your opinion about colonoscopy and intestinal ultrasound (IUS) in the management of IBD? (Multiple options can be selected) *

Colonoscopy provides most accurate assessment of inflammation but it is limited to evaluation of intestinal mucosa

IUS is non-invasive and evaluates the morphology of all layers of the intestinal wall

Colonoscopy still is the gold standard in the diagnosis of IBD and should be preferred over IUS

IUS should be preferred over colonoscopy for the diagnosis of IBD as it is non-invasive

IUS screening is likely to be more beneficial in CD rather than ulcerative colitis

Colonoscopy and IUS both are vital imaging modalities to diagnose IBD.

Despite advances in diagnostic procedures differentiating CD from intestinal TB and vice versa, diagnosis of CD remains a major issue *

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

Which scale/scoring system do you use to assess the severity of ulcerative colitis? (Multiple options can be selected) *

Full Mayo score

Partial Mayo score

Truelove-Witts classification

Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score

Oxford (Travis) index

Ho index

Scoring system is not used in routine clinical practice

Any other

Which guidelines do you follow in your practice for the management of IBD? (Multiple options can be selected) *

European Crohn’s and Colitis Organisation (ECCO) guidelines

American Gastroenterology Association (AGA) guidelines

American College of Gastroenterology (ACG) guidelines

British Society of Gastroenterology (BSG) guidelines

Japanese Society of Gastroenterology guidelines

Indian Society of Gastroenterology (ISG) guidelines

Any other

How many mild to moderately active IBD patients in your practice do not respond adequately to conventional therapy and corticosteroids? *

<10%

11-20%

21-30%

>30%

Any other

When do you consider to escalate treatment from conventional therapy or corticosteroids to biologicals in the management of IBD? (Multiple options can be selected) *

Inadequate symptomatic response

Clinical response but no mucosal healing

High dose maintenance therapy

Corticosteroid dependence

How many patients of IBD do you treat with biologics in a year? *

< 10

10 -20

21 – 50

> 50

When do you prescribe adalimumab in the management of moderately to severely active UC and CD? *

First line therapy

After inadequate response to conventional therapy

After inadequate response to infliximab

After inadequate response to tofacitinib

Any other

According to you which are the below parameters favour adalimumab in the management of moderately to severely active UC and CD? (Multiple options can be selected) *

Subcutaneous route of administration

Cost effective therapy

No hospitalization is required for drug administration

Efficacy has been proven in multiple clinical trials

Favourable safety

Antidrug antibody formation is comparatively less

No specific preferable parameters

What is the average duration of adalimumab therapy for the management of IBD in your practice? (Multiple options can be selected) *

< 6 months

1-2 years

> 2 years

Any other

How long does it take to achieve clinical remission with adalimumab in moderately to severely active UC? *

Less than a month

1-3 months

3-6 months

6-12 months

>1 year

How long does it take to achieve clinical remission with adalimumab in moderately to severely active CD? *

Less than a month

1-3 months

3-6 months

6-12 months

>1 year

What percentage of moderately to severely active IBD patients do not adequately respond to adalimumab in your practice? *

< 5%

5-10%

11-20%

21-25%

>25%

What are the causes of inadequate response to adalimumab in patients with IBD as per your experience? (Multiple options can be selected) *

Poor patient compliance

Incorrect administration by the patients

Insufficient blockade of TNF due to development of anti-drug antibodies leading to low serum concentration

Primary failure of adalimumab

High concentration adalimumab i.e., 40 mg in 0.4 ml can improve patient compliance as compared to low concentration adalimumab i.e., 40 mg in 0.8 ml as there is less injection related pain due to less volume is injected with high concentration formulation *

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

High concentration adalimumab has favourable safety profile (lower incidence of injection site reactions or other adverse effects) compared to low concentration adalimumab *

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

What is your observation about the efficacy of high concentration adalimumab compared to low concentration adalimumab in the management of IBD? *

Comparable efficacy

Less efficacy than low concentration adalimumab

More efficacy than low concentration adalimumab

Not able to comment as I did not differentiate between two formulations

What is your experience about the development of anti-drug antibodies (ADA) with adalimumab? *

Do not monitor ADA if loss of clinical response occurs and assess clinically

Development of ADA is seen rarely

Development of ADA is seen infrequently

Development of ADA is seen frequently

Development of ADA is seen in

% of patients

What is your experience about relapse rate with adalimumab therapy once clinical remission is achieved in the management of IBD? (Multiple options can be selected) *

Relapse rate is less when adalimumab is discontinued but azathioprine is continued

Relapse rate is less when azathioprine is discontinued but adalimumab is continued

Relapse rate is less when adalimumab and azathioprine both the drugs are discontinued and 5-ASA is continued

Relapse rate is less when adalimumab and azathioprine both the drugs are continued.

What is your approach when patient comes with relapse after discontinuation of adalimumab? (Multiple options can be selected) *

Restart adalimumab if discontinuation was done after achieving the clinical remission

Restart adalimumab if discontinuation was done due to poor patient compliance and cost of therapy

Start treatment with other TNF α blocker if discontinuation was due to inadequate response to adalimumab

Start treatment with biologics from other class apart from TNF α blockers if discontinuation was due to inadequate response to adalimumab

Start treatment with biologics from other class apart from TNF α blockers if discontinuation was due to development of anti-adalimumab antibodies

Start treatment with JAK inhibitors if discontinuation was due to development of anti-adalimumab antibodies

What is your clinical experience with adalimumab and azathioprine combination therapy Vs infliximab and azathioprine combination therapy in the management of IBD? *

Patients respond better to adalimumab and azathioprine combination

Patients respond better to infliximab and azathioprine combination

There is no difference in the clinical outcome between two regimens

Azathioprine is less commonly used along with biologics due to unfavourable safety profile of combination therapy

What is your approach to prevent reactivation of pulmonary or extra pulmonary tuberculosis with TNF-α blockers? *

Patients are screened for latent and active tuberculosis before giving adalimumab and during treatment

Patients are treated with anti-tubercular drugs if latent or active tuberculosis is detected before giving adalimumab

Adalimumab is not prescribed to patient with history/suspicion of tuberculosis

Consultation with physician with expertise in the treatment of tuberculosis to decide whether initiating anti-tuberculosis therapy is appropriate for an individual patient

Which tests do you use to screen latent tuberculosis infection before initiating treatment with TNF-α blockers? (Multiple options can be selected) *

Chest radiograph

T-cell interferon-gamma release assay (IGRA)

Tuberculin skin test (TST)

TST with IGRA

TST with QuantiFERON TB Gold

Chest radiograph and TST with IGRA

QuantiFERON TB Gold

Any other

What approach do you follow to reduce the risk of bacterial, viral and fungal infections with adalimumab in the management of IBD? (Multiple options can be selected) *

Patients are screened before starting adalimumab

Patient education and vaccination is recommended before starting adalimumab

Patients are closely monitored during adalimumab therapy for various infections

Concomitant use of adalimumab and other immunosuppressants is avoided to treat IBD

Adalimumab is avoided in patients 65 years of age and older

Adalimumab is avoided in patients with co-morbid conditions

What do you do if infection develops during treatment with adalimumab? *

Continue adalimumab and start treatment for the infection simultaneously

Stop adalimumab, treat infection and start other TNF α blocker once infections are resolved

Stop adalimumab, treat infection and resume adalimumab once infection is resolved

Stop adalimumab, treat infection and start other biologics apart from TNF α blocker once infection is resolved

What approach is followed to minimize/ avoid risk of malignancies during treatment with adalimumab? *

Adalimumab is not prescribed in patients with prior history of any malignancy

Adalimumab is not prescribed if patient is already taking immunosuppressant for other illnesses

Adalimumab is avoided in patients 65 years of age and older

Adalimumab is avoided in patients with co-morbid conditions

Adalimumab is avoided in patients with family history of malignancy

Which of the following drug is preferred when cardiac ailment such as myocarditis or ischemic heart disease or pericarditis is present as extraintestinal manifestations in your patient with IBD? *

Adalimumab along with specific treatment for cardiac ailment

Infliximab along with specific cardiac treatment

Golimumab along with specific cardiac treatment

Tofacitinib along with specific cardiac treatment

Any other biological with specific cardiac treatment (Please mention name of biological

How do you manage pulmonary diseases such as pneumonitis or interstitial lung disease as extraintestinal manifestations of IBD? *

Adalimumab along with specific disease treatment

Infliximab along with specific disease treatment

Golimumab along with specific disease treatment

Tofacitinib along with specific disease treatment

Refer to pulmonologist for further treatment for pulmonary disease

Any other

How do you manage cutaneous diseases such as pyoderma gangrenosum or erythema nodosum as extraintestinal manifestations of IBD? *

Adalimumab along with specific skin disease treatment

Infliximab along with specific skin disease treatment

Golimumab along with specific skin disease treatment

Tofacitinib along with specific skin disease treatment

Refer to dermatologist for further treatment for skin disease

Any other

How do you manage ocular diseases such as uveitis or scleritis or episcleritis as extraintestinal manifestations of IBD? *

Adalimumab along with specific ocular disease treatment

Infliximab along with specific ocular disease treatment

Golimumab along with specific ocular disease treatment

Tofacitinib along with specific ocular disease treatment

Refer to ophthalmologist for further treatment for ocular disease

Any other

{{ $ActivityTypeName }}

A Survey Among Gastroenterologists to Understand Management of Inflammatory Bowel Disorder (IBD) in India with Focus on Therapy with Biologicals (REASSURANCE Study)

Survey Questionnaire Form

Doctor's details

Questionnaire