Q: What are the latest advances in IBD therapy today?
A: In IBD therapy, there are three components: medical therapy, surgical therapy and a growing area of endoscopic therapy. Here’s a quick look at what’s new medical therapy-wise.
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Large-molecule biological agents – There have been a lot of advances in medical therapy within the past 10 years. One of the main advances we’ve seen is that we now have numerous large-molecule biological agents available, with the U.S. FDA approving a new one every one to two years. In addition is the good news ― because biological agents have cost-issues associated with them ― that an increasing number of biosimilars are also becoming available.
Now, of course, large-molecule biological therapy has advantages and disadvantages. One of the disadvantages is that it’s easy to develop antibodies against these drugs. So after using for years, patients lose a response to the drug. How do we perfect this? Through therapeutic drug level monitoring, we measure the antibody level against the drug and try to prolong the efficacy.
Another current concept is the treatable target. We aren’t satisfied just by the patient’s symptom response, we need an objective response. This means visually seeing, or at least use a quantitative marker to see if inflammation is gone. By preventing the inflammation, you can prevent complications ― especially mechanical complications, such as stricture and fistula, which eventually require surgery.
Small-molecule pathway-targeted molecules – We also now have a small-molecule pathway-targeted molecule available for treating IBD. The FDA will likely soon approve the first small-molecule drug for ulcerative colitis. Naturally, the small molecule has advantages and disadvantages as well. It’s very potent, easy to take and it’s anticipated that their effect will last longer. However, there are safety concerns since it’s so new.
With all of these new therapies on the market, that’s why discussion among gastroenterologists and colorectal surgeons is so important.
Hear more from Dr. Shen and his colleagues from Cleveland Clinic’s Center for Inflammatory Bowel Disease at the Dr. Victor Fazio IBD Symposium in Medical & Surgical Treatment of Crohn’s Disease and Ulcerative Colitis during DDW 2018 on June 3.