Neurogastroenterol Motil. 2021 Dec;33(12):e14145. doi: 10.1111/nmo.14145. Epub 2021 Apr 2.

Christopher V Almario ^{1 2 3 4 5}, Samuel Eberlein ³, Carine Khalil ³, Brennan M R Spiegel ^{1 2 3 4 6}

Author information

¹Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.

²Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.

³Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.

⁴Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA.

⁵Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California, USA.

⁶Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.

Abstract

Background: Many patients with irritable bowel syndrome (IBS) experience acute and unexpected pain episodes over and above chronic background symptoms, and there are emerging medications designed to treat such pain. We aimed to use conjoint analysis-a technique that elucidates how people make complex decisions-to examine patient preferences for emerging medicines for breakthrough IBS pain.

Methods: We conducted a cross-sectional conjoint analysis survey among patients with Rome IV IBS and recurrent episodes of acute pain to assess the relative importance of medication attributes in their decision-making. We also assessed what respondents would require of subcutaneous (SQ) therapies to consider their use.

Key results: Among 629 patients with Rome IV IBS, 606 (96.3%) reported ≥1 acute pain episodes in the past month. For the 461 participants with multiple attacks who completed the conjoint analysis, they prioritized medication efficacy (importance score 34.9%), avoidance of nausea (24.3%), and avoidance of constipation (12.2%) as most important in their decision-making. These were followed by route of administration (10.3%), avoidance of headache (9.3%), and avoidance of drowsiness (8.9%). Moreover, 431 (93.5%) participants would consider SQ therapies for their acute pain; they had varying expectations on the minimum pain decrease and onset and duration of pain relief needed for considering their use.

Conclusions and inferences: The vast majority of patients with IBS experience breakthrough pain, and when selecting among therapies, they prioritize efficacy and most are willing to use a rapid-acting SQ treatment. These results support development of novel, effective medications-oral or SQ-for management of acute pain attacks.