AUSTIN, Texas — In this exclusive video from Crohn’s & Colitis Congress, James Lindsay, PhD, FRCP, professor of inflammatory bowel disease at Barts and the London School of Medicine and Dentistry, Queen Mary University of London and a consultant gastroenterologist at Barts Health NHS Trust, discusses positioning therapies in ulcerative colitis.
“[It is] important ... to recognize that although ulcerative colitis is a mucosal disease, it can still progress and cause negative outcomes for our patients,” Lindsay told Healio Gastroenterology and Liver Disease. “It could progress in terms of the disease extending from proctitis to extensive colitis and that signifies a worse prognosis outcome. It can progress in terms of functional outcomes as well of course as to the well-known complication of dysplasia.”
As a result, Lindsay noted that ulcerative colitis treatment has evolved over the last several years and that physicians are not just satisfied with clinical or steroid free remission.
“We’re aiming for an improvement of remission in patient reported outcomes as well as either mucosal or histological healing and of course the good news from this perspective is there are a whole range of new biologics and small molecule therapies that we can choose from to achieve this goal,” he said.
However, the appropriate positioning of those therapies is critical in determining the right drug for the right patient.
The most critical thing, according to Lindsay, is to get the basics right before doing anything else.
For instance, he notes how mesalamine is a safe and effective mild-to-moderate UC treatment option, as are corticosteroids. But they are relatively short-term treatment options and an appropriate maintenance strategy is needed, according to Lindsay.
Additionally, while there is evidence that supports the use of azathioprine in UC, biologics such as infliximab (Remicade, Janssen), particularly when used in combination with azathioprine are considered more effective.
“When it comes to trying to choose between the new biologics and small molecules ... we need to look at the factors that differentiate between them,” he said in an interview. “Differences in efficacy in persistence in therapy, in safety and of course relating to cost.”
In the future, Lindsay said he expects to have several new “tools in our box” to help position therapies.
“Positioning therapies in ulcerative colitis is crucially important because we need to make sure that we achieve that goal of getting ... and keeping patients better both in terms of their symptoms, but also in terms of healing their mucosa,” he said. “Getting initial therapy with the conventional drugs right is essential because a lot of patients will never need to move on to biologic therapies, but once you have done that, irrespective of what your choice of treatment is, having a strategy in place that allows you to monitor effectiveness and safety of these drugs will improve patient outcomes.” – by Ryan McDonald
Lindsay J. Sp67. Presented at: Crohn’s and Colitis Congress; Jan. 23-25, 2020; Austin, Texas.
Disclosures: Lindsay reports serving as a consultant and advisor for AbbVie, Allergan, Atlantic Healthcare, Celgene, Celtrion, Ferring, Gilead, GlaxoSmithKline, Janssen, Eli Lilly, MSD, Napp, Pfizer, Shire, Takeda and Vifor Pharma.