IBD treatment algorithm should be optimized, personalized for patients
MAUI, Hawaii — Physicians should optimize and personalize the treatment algorithm for patients with inflammatory bowel disease, according to an expert at GUILD Conference 2020.
“There was little we could do to alter the natural history [20 years ago],” Adam S. Cheifetz, MD, director of Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center and a professor of medicine at Harvard Medical School said during his presentation. “Now, where we have multiple drugs with multiple mechanisms, and many more coming down the pipeline, we have to get better in how we treat our patients.”
Cheifetz said physicians should be focusing on disease treatment early on, before complications arise.
“What we want to do is change the natural history of inflammatory bowel disease, get rid of the complications, get rid of the surgeries and get your patients well,” he said.
He also said mucosal improvement is significant in IBD treatment because “healing the mucosa is associated with less flares, less complications, less hospitalizations and less surgeries,” according to an increasing amount of evidence.
Cheifetz said proactive therapeutic drug monitoring (TDM) should be used for dose optimization. Results from a recent study he had a part in conducting found that “higher drug concentrations are associated with better outcomes, and undetectable or low drug concentrations are associated with loss of response and antibody development.”
He also said there is a need to, like oncologists, examine phenotypes and genotypes to determine the best drug for patients.
Cheifetz said he uses optimized monotherapy with proactive TDM for more severe ulcerative colitis and Crohn’s disease in his practice, noting that the next-best option is Remicade (infliximab, Janssen) with an immunomodulator. He does not use steroids in IBD treatment, as they “increase risk of serious infection and mortality.”
“When we see a patient with new-onset IBD, we have to think about treating them smarter and trying to predict who’s going to have a more aggressive disease course, not just what their symptoms are now, not just what their disease activity is, but what their disease severity is as well and what’s their risk of developing significant complications and even surgery.” – by Kalie VanDewater
Cheifetz AS. Treatment of (new onset) IBD. Presented at: GUILD Conference; Feb. 16-19, 2020; Maui, Hawaii.
Disclosure: Cheifetz reports he receives consultant fees from AbbVie, Arsanis, Bacainn, EMD Serono, Grifols, Janssen, Pfizer, Prometheus, Samsung Arena and Takeda. He also reports receiving research support from Inform Diagnostics.