Siegel CA et al. (2008) Patient perceptions of the risks and benefits of infliximab for the treatment of inflammatory bowel disease. Inflamm Bowel Dis 14: 1–6

Infliximab is a chimeric, monoclonal antibody to tumor necrosis factor; this therapy induces or maintains remission of Crohn's disease and ulcerative colitis in ∼60% of cases, even if other treatments have failed. Serious adverse effects of infliximab therapy are rare, but include lymphoma and life-threatening infections.

Siegel and colleagues analyzed 165 completed questionnaires that evaluated perceived risks and benefits of infliximab therapy. Respondents were patients, or parents of patients, with IBD who attended patient-education symposia in Boston, MA and Chicago, IL. Respondents overestimated the benefits of infliximab (59% expected a remission rate >50%, and 18% expected a remission rate >70%, at 1 year). They also underestimated its risks: 37% denied a link between infliximab and lymphoma, and 67% thought that infliximab conferred a lymphoma risk less than double that of the general population (the observed risk is ∼20-fold that of the general population). When presented with a hypothetical new therapy for IBD that had a risk profile corresponding to that of infliximab, 64% of respondents said they would refuse such treatment, even though one-third of this group were currently taking or had taken infliximab. Parents of patients were less optimistic than patients with regard to both risks and benefits of infliximab therapy.

Many patients with IBD could be taking medications that do not align with their risk–benefit preferences, say Siegel and colleagues. They urge physicians to communicate more effectively with their patients.