Best Practices in the Management of IBD During COVID-19 - Episode 1

Concerns Surrounding Increasing Rates of Inflammatory Bowel Disease

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Miguel Regueiro, MD: Welcome to this HCPLive® Peers & Perspectives® presentation, titled “Best Practices in the Management of IBD During COVID-19.” I’m Dr Miguel Regueiro from the Cleveland Clinic, and I’m so happy that I’m being joined today by Dr Jean-Fred Colombel from the Icahn School of Medicine at Mount Sinai in New York and Dr Doug Wolf of Atlanta Gastroenterology Associates to discuss the management of IBD [inflammatory bowel disease] using biologics during the COVID-19 [coronavirus disease 2019] pandemic. Doug and Jean-Fred, welcome today.

It’s a pleasure having you join me, and I always enjoy these panels. I just wish we were in person.

Doug, let me start with you to kick us off with an interesting overview on the incidence and prevalence of IBD. What do you tell your patients, and what would you tell your colleagues in terms of incidence and prevalence of IBD?

Douglas C. Wolf, MD: I tell them that the incidence of IBD is increasing over time, and the most recent numbers suggest that there are approximately 10.7 new cases for every 100,000 people for Crohn disease; for ulcerative colitis [UC], it’s 12.2 for every 100,000 people. What that translates to is 33,000 new cases of Crohn disease every year and 37,000 new cases of ulcerative colitis.

Those numbers, of course, aren’t exact; they’re rough. But they show somewhere around 70,000 new cases of IBD every year. As far as the prevalence, it’s in the range of 1.6 million patients in the United States, and those numbers range depending on who is doing the analyses.

Miguel Regueiro, MD: Right. We’ve seen numbers as high as 3 million, but I agree. It is probably 1.6 to 2 million. To your point Doug, it’s interesting that this increase is not genetics. There are some clear environmental impacts. Jean-Fred, I know you’ve done a lot of research and you have a lot of interest in this. Are there any recent data on incidence and prevalence in IBD?

Jean-Frederic Colombel, MD: Yes. I would like to take a global, worldwide perspective, because what is most striking is that IBD is now a disease of the whole world. There was a recent review paper, and I encourage you to read this paper summarizing the history of IBD.

There are 4 different phases. First, there is emergence of the disease. For us it was in the 1950s. For newly industrialized countries, it was 20 years ago. And for the developing countries, it’s now. The second phase is a rapidly rising incidence. The third is then a compounding prevalence where the incidents are increasing, and the prevalence is increasing as well. Then you will eventually have an equilibrium because then the incidence will equal mortality. This is an important point, especially in our countries because our IBD population is aging.

What should we expect? Let’s take the United States. We should expect that we will switch from approximately 0.7% of all people from the United States affected to 1%, meaning that it will be that we should have 3.5 million patients with IBD. But 3.5 million is huge, and that’s the first problem. Second, we need to face an aging population, meaning that we’ll have more and more patients in their 60s and so on, and this will pose some very important health care problems, I believe.

In the newly industrialized countries, they are seeing a rising incidence. There are a lot data from Asia thanks to the access registry, and there are now some interesting emerging data from Latin America as well showing the same trend: UC is coming first, then Crohn disease. And then rapidly Crohn disease is taking over. It is very interesting.

Miguel Regueiro, MD: As you said, this incidence and prevalence is very interesting. It’s somewhat scary when you look at the numbers that we have seen and those we’re going to see in next decade as people age with this, and there are new cases. Doug, you already alluded to the idea that this is increasing, but with this increase, we’re also more than ever looking at the natural course of the disease. Can you speak for a minute on the progressive, relapsing nature of IBD? What does that mean? How would you tell that to your patient or to a colleague?

Douglas C. Wolf, MD: This has been best described in Crohn disease, but both are chronic conditions; there is no cure. Our goal, especially in our treat-to-target era, is to get the conditions under control and keep the disease inactive. Historically, without any effective medication intervention, these conditions have been chronic and progressive with continued complications. In Crohn disease, there are data from Europe that show there is roughly a 70% to 80% risk of complications over a 20-year period.

Hopefully, now that we’re in the age of biologics, this is reduced. When you have complications, there are more hospitalizations and higher expense. Hopefully, we’re able to control these things with better management. Similar data exist in ulcerative colitis, for which a significant number of patients in the past have required surgical proctocolectomies and ileostomies, now we have with J-pouch [ileoanal anastomosis surgery] but with better medications. We can avoid or at least limit and reduce the number of surgical interventions and hospitalizations.

Transcript Edited for Clarity