From awareness to action: Addressing uncontrolled UC and CD with rapid efficacy
Industry Buzz
Although there are many more options available to patients now, not all patients respond to therapy. Sometimes up to 30%-40% will not respond to primary therapy, and there can be a loss of response to therapy after a period of time.
—Sean Lee, MD, a gastroenterologist at GI Partners of Illinois
By intervening early and starting patients on an advanced therapy—biologics or JAK inhibitors—at the time of diagnosis, we have a better chance of preventing lasting damage to the bowel. Early intervention can limit the need for steroids or surgery.
—Peter Higgins, MD, chair of the Crohn’s & Colitis Foundation’s National Scientific Advisory Committee
In clinical practice, the term uncontrolled ulcerative colitis (UC) or uncontrolled Crohn’s disease (CD) hints at more than just persistent symptoms: it implies that conventional therapies may simply be failing patients.
Condition refresher
Sean Lee, MD, a gastroenterologist at GI Partners of Illinois, says uncontrolled CD or UC can be defined in multiple ways. “Clinically, it can include symptoms of diarrhea, rectal bleeding, and abdominal pain or cramping.” Generally, symptoms of CD and UC are heterogeneous and can also include extraintestinal manifestations.[]
To diagnose uncontrolled CD and UC, there are a few things you can do. “[Look for] laboratory evidence of active inflammation through stool testing and blood tests,” Dr. Lee says, “as well as endoscopic evidence with visual confirmation of the inflammation of the lining of the GI tract.”
Although there is a wide range of available treatments, patients don’t always get better.[] According to a review in Best Practice & Research Clinical Gastroenterology, traditional management focuses on symptom control, which doesn’t always work and can lead to uncontrolled CD or UC.[] “[It] fails to prevent long-term complications such as disease progression, disabilities, hospitalizations, and surgeries,” the authors write.
Current limitations
Dr. Lee says clinicians must be aware of the limitations of current therapies. “Although there are many more options available to patients now, not all patients respond to therapy,” he says. “Sometimes up to 30%-40% will not respond to primary therapy, and there can be a loss of response to therapy after a period of time.” These non-remitters and partial remitters are more likely to have increased symptom severity, mental health burdens, and worse quality of life.[]
Current therapeutic strategies, like anti-TNF agents, anti-integrins, and IL-12/23 inhibitors, have undoubtedly transformed IBD care but have considerable limitations when it comes to speed of onset, efficacy, and other variables.[][]
As Dr. Lee explains, “Most of the newer, more effective therapies target the immune system, and immunosuppression can make patients more susceptible to certain types of infection.”
Reshaping the treatment landscape
Still, the landscape is evolving, with rapidly working treatments coming to market. These include biologics, small molecules, microbiome therapy, gene therapy, and stem cell treatments.[] The treat-to-target (T2T) approach—which focuses on specific, pre-defined goals (like remission)—is now shaping the IBD treatment landscape.[]
Treatment timing is key, according to Peter Higgins, MD, chair of the Crohn’s & Colitis Foundation’s National Scientific Advisory Committee.[] “By intervening early and starting patients on an advanced therapy (biologics or JAK inhibitors) at the time of diagnosis,” he says, “we have a better chance of preventing lasting damage to the bowel. Early intervention can limit the need for steroids or surgery.”