Sa1764 PERCEPTION OF REMISSION AND PREFERENCE FOR DISEASE SYMPTOMS IN PATIENTS WITH CROHN'S DISEASE: RESULTS FROM A DISCRETE CHOICE EXPERIMENT

Background Crohn's disease (CD) is an inflammatory bowel disease involving periods of flare and remission.The aim of this study was to assess factors that influence patients' perceptions of remission, patients' preferences for disease symptoms, and maximum acceptable increases in pain.Methods A web-based survey was developed for adults in the US with self-reported moderate-to-severe CD.The survey included a discrete choice experiment (DCE) element that examined 12 pairs of symptoms profiles associated with CD.In the DCE, patients indicated which profile in each pair they would prefer, and whether each profile described flare or remission.Disease attributes are in Table 1.Responses were analyzed using binary (perception) and mixed (preference) logit models.Results Overall, 193 patients completed the survey; of these, 151 (78.2%) were experiencing a flare at the time, and 42 (21.8%)were in remission.All attributes were considered important in patients' perceptions of remission (all p < 0.007), except for obvious bloody stools vs blood only (p = 0.438).Patients were more likely to associate a lower number of bowel movements (1/ day vs 12/day; odds ratio [OR] 5.95; 95% confidence interval [CI] 4.87-7.26),less severe endoscopy results (none vs severe inflammation; OR 3.23; 95% CI 2.66-3.94)and less severe abdominal pain (2 vs 8 on the Numeric Rating Scale [NRS]; OR 2.70; 95% CI 2.23-3.26)with remission (all p < 0.001).All attributes significantly influenced patients' preferences for health profiles, except for obvious bloody stools vs blood only: 1 bowel movement/day was preferred over 12/day (beta coefficient 1.70; 95% CI 1.39-2.01);less severe abdominal pain (NRS score of 2) was preferred versus a score of 8 (beta coefficient 0.96; 95% CI 0.70-1.22);and normal endoscopy results were preferred to severe inflammation (beta coefficient 1.00; 95% CI 0.76-1.24).Table 2 shows the importance of attributes in patients' decisionmaking.Patients were willing to accept an increase in pain for an improvement in any DCE level in all attributes, except for worst bloody stools, for which only changes from blood alone to no blood or streaks of blood were seen as significant (maximum acceptable increase in pain of 3.17 or 1.90 points, respectively).Patients were willing to accept an increase in pain of 9.85 for a reduction in number of bowel movements from 12/day to 1/day, and of 6.24 for a reduction from 12/day to 3/day.Conclusion The patient-perceived importance of endoscopy results and number of bowel movements is aligned with clinical endpoints used in trials assessing CD treatment; pain remains an important consideration for patients.In addition, treatment for CD needs to be associated with an almost complete reduction in bloody stools to significantly influence patients' preferences.Table 1 CD symptoms and levels of severity used in the DCE.CD, Crohn's disease; DCE, discrete choice experiment; NRS, Numeric Rating Scale