Conflicts of Interest in Inflammatory Bowel Disease Articles on UpToDate

Abstract

Background Financial conflicts of interest (FCOIs) are widespread in inflammatory bowel disease (IBD) and may be particularly important in point-of-care (POC) resources, such as UpToDate, that are used to aid clinical decision making. In this study, we determined the prevalence of industry payments from companies making biologic medications for IBD to contributors of UpToDate articles on IBD. Methods This cross-sectional analysis included UpToDate articles that mention the use of biologic medications for IBD. We collected the names of the contributors (authors and editors) and their disclosures on UpToDate. We then searched for their names on the Center for Medicare and Medicaid Open Payments database and compared the payment information from 2013 to 2018 with UpToDate's disclosures. We presented data per episode, which describes one instance of participation by one person in one article, regardless of whether that person contributed to multiple articles. Results We identified 23 articles on the treatment of Crohn's disease and ulcerative colitis that mentioned the use of biologic medications, with 86 total episodes. Sixty-two (72%) episodes involved FCOIs. The median payment associated with each episode was $$55 (interquartile range = $44 to $145,241). Contributors did not fully disclose FCOIs in 41 (48%) episodes. Deputy editors, who are required to be free of FCOIs, in general did not have substantial episodes involving FCOI. Conclusions We found that UpToDate articles on inflammatory bowel disease involve substantial FCOI, many of which are not disclosed. The presence of these FCOIs may hamper trust in the objectivity of treatment recommendations.

Characteristics and conflicts of interest at Food and Drug Administration Gastrointestinal Drug Advisory Committee meetings

“…One area that merits further exploration is that of COI among GIDAC members. Previous studies have established the high prevalence COI are common in other areas in gastroenterology, with previous studies showing a high prevalence of industry payments related to GI guidelines and point-of-care articles on IBD [ 15 , 24 , 25 ]. In this study, 12 (35%) of 34 meetings had at least one member who had a COI with a sponsor and 33 (6.9%) of 476 votes involved COI with a sponsor.…”

Examination of Potential Industry Conflicts of Interest and Disclosures by Contributors to Online Medical Resource Databases

“…UpToDate 18 and DynaMed were selected based on their favorable ratings in empirical evaluations of the breadth of coverage, timeliness of updating, use of evidence-based methods, and utility; 19 , 20 , 21 because our library subscribed to them; and to extend prior research that showed that COI were prevalent 7 , 8 , 9 with some concerns about disclosure accuracy. 9 UpToDate has entries for more than 12 000 clinical topics and more than 6900 drug entries, with more than 2 million users in 191 countries and territories.…”

“… 5 , 6 However, there is limited research on the potential COI among authors and editors of online clinical resources, such as UpToDate and DynaMed. 7 , 8 , 9 …”

“…5,6 However, there is limited research on the potential COI among authors and editors of online clinical resources, such as UpToDate and DynaMed. [7][8][9] UpToDate and DynaMed are online, subscription-based products used by physicians to assist in clinical decision-making. Both UpToDate and DynaMed promote their websites as evidence-based resources for physicians to improve patient health outcomes at the point of care.…”

“…7 Examination of 23 UpToDate articles for the treatment of Crohn disease and ulcerative colitis determined that almost half of contributors (48%) did not fully disclose their COI. 8 We investigated potential COI among a broad sample of content contributors for DynaMed and UpToDate by cross-checking their self-reported disclosure against financial records available from OP and verifying these with DFD. Additionally, a descriptive analysis of UpToDate and DynaMed content contributors' disclosure status, financial compensation, and gender was performed, with further evaluation of each database's top 10 physician-contributors who received payments.…”