The inflammatory bowel disease (IBD) session covered optimal ways to initiate treatment for ulcerative colitis and Crohn’s disease, when and how to discontinue some of those treatments, and the use of biosimilars as substitutes for biologic therapies. Finally, suggestions were provided regarding the often-challenging identification of irritable bowel complaints in patients with IBD.
Dr. David S. Weinberg
Uma Mahadevan, MD, opened by reviewing important patient factors to consider, such as disease type and severity, comorbidities, and previous therapies, before the initiation of anti-inflammatory, immunomodulatory, and/or biologic therapies in patients with IBD. She underlined the importance of risk stratification in selecting optimal therapies as well as the role of steroid-sparing agents, and she discussed the preferability of a “treat to target” strategy that emphasizes clinical, laboratory, and endoscopic response. Finally, Dr. Mahadevan, of the University of California, San Francisco, provided an overview of the role of tofacitinib (Xeljanz), which was recently approved for the treatment of moderate to severe ulcerative colitis.
Millie D. Long, MD, MPH, discussed the clinical challenges associated with stopping biologic and/or immunomodulator therapy in selected patients with IBD. Long-term use of immunomodulators and biologics can be associated with increased risk of malignancy. Dr. Long, of the University of North Carolina, Chapel Hill, reviewed data suggesting that approximately 50% of patients will relapse within 2 years of withdrawing from either class of agents. For patients on dual therapy, similar rates are seen on withdrawal of biologics alone, although most patients can be brought back under control with drug reinitiation. In general, withdrawal is predicted to be most effective in patients who have had a durable response for at least 6-12 months with clinical, laboratory, and endoscopic evidence of remission.
Around the world, use of biosimilar anti–tumor necrosis factor agents is growing. Peter Lakatos, MD, PhD, AGAF, director of IBD Centre at McGill University, Montreal, reviewed the current literature, which demonstrates very similar clinical performance between the first generation of biosimilars and more traditional agents from this class. Food and Drug Administration approval in the United States has been slower than elsewhere. However, it is expected that multiple agents already used or under development outside this country will be available in the United States in the next several years. Biosimilars have already captured 50% of the European market and, because of cost considerations, their use is mandatory in some non-U.S. settings.
In some patients, differentiating an IBD flare from superimposed irritable bowel syndrome symptoms can be difficult. Charles Bernstein, MD, of the University of Manitoba (Canada), emphasized the importance of exploring perceived stress in the life of patients with IBD. Stress can be the dominant factor driving clinical complaints in the absence of identifiable increases in inflammatory activity, he explained.
Dr. Weinberg is chairman of the department of medicine, Fox Chase Cancer Center, Philadelphia. This is a summary provided by the moderator of one of the spring postgraduate course sessions held at DDW 2018.
