The Present and Future of Inflammatory Bowel Disease Treatment. William J. Sandborn, MD. Gastroenterol Hepatol (N Y). 2016 Jul; 12(7): 438–441.
What are the most significant unmet needs in current inflammatory bowel disease treatment?
William J. Sandborn, MD. “With the current biologic drugs, approximately 20% to 35% of patients will achieve remission, and approximately 45% to 60% of patients will achieve response or remission. Conversely, this means that 40% to 55% of patients have no response to therapy, and 65% to 80% of patients do not experience a full remission. In addition, patients who respond to biologic drugs can lose response over time. For example, they may develop antidrug antibodies to the biologic drug, which can lead to loss of response. Thus, there is a substantial number of patients who fail to respond or fail to fully remit, or who lose response. The associations of azathioprine, 6-mercapto-purine, and anti-TNF agents with lymphoma and serious and opportunistic infections, as well as the associations of azathioprine and 6-mercaptopurine with skin cancer, are not ideal either. Therefore, having drugs or drug combinations for all patients that are highly effective and that do not have infectious or malignant side-effect profiles is an important unmet need.
Also, having additional oral therapies and having biologic therapies that are administered subcutaneously on an infrequent basis would be desirable from a patient compliance and convenience standpoint.”
IBD Therapy, Novel Targets and Unmet Needs
Inflammatory bowel disease (IBD) is a chronic progressive disease. While current therapeutic strategies aim to control symptoms, these have not significantly altered the natural history of IBD. To that end, Dr Colombel proposes treating IBD to the target of endoscopic healing, together with tight control of inflammation. To achieve this target, optimization of current therapies is required. A thorough understanding of pharmacokinetics is also important. Knowledge about the predictors of disease progression is also important to avoid under- and over-treatment. In time to come, Dr Colombel is optimistic that an integrated approach incorporating genetics with clinical and environmental data will help clinicians to develop personalized, targeted therapies for patients. In this era of increasing complexity of care, patient education is also vital. Involving patients while making treatment decisions is mandatory for the success of any management strategy.
The unmet need in inflammatory bowel disease in one chart
Over the last 20 years there has been major innovation in treatment of Inflammatory Bowel Disease (IBD) catalyzed due the biologics that offer greater on target selectivity than aminosalicylates, corticosteroids or immunosupressants.
Several of these biologic therapies target the integrin family of adhesion receptors
These biologic drugs need to be injected or infused but patients with a chronic disease prefer the convenience of an oral drug that allows them to maintain an active lifestyle.
There has been a drought in innovation. It’s been decades since patients have had new classes of oral drugs.
Educational Needs of Patients with Inflammatory Bowel Disease (IBD) and Non-Adherence to Medical Therapy-A Qualitative Study. Wheat CL, Maass M, Devine B, Thornton TY, Grembowski D, et al. (2016) J Inflam Bowel Dis & Disord 1: 106. doi:10.4172/jibdd.1000106
The Challenges of Living with Inflammatory Bowel Disease: Summary of a Summit on Patient and Healthcare Provider Perspectives. Canadian Journal of Gastroenterology and Hepatology. Volume 2016 (2016).