Optimal Management of Biologics in Crohn’s Disease - Episode 14

Emerging Therapies and Challenges for Crohn’s Disease

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Dr Anita Afzali and Miguel Regueiro discuss emerging therapies and combinations in the pipeline for Crohn’s disease as well as unmet needs in the field for disease management.

David P. Hudesman, MD: Dr Afzali, we've talked about many different options and in the next 1, 2, 5 years there's going to be newer options as well. Some similar mechanisms, some a little bit different. Could you just briefly comment on what you're most excited about?

Anita Afzali, MD, MPH, MHCM, FACG, AGAF: I'm excited about a lot of stuff. As the pipeline and the medicine cabinet is expanding it gives me additional hope and certainly for our patients it helps them as well. I appreciate that again going back to how studies are now being designed where it's more of the type of patients we see in clinic in a sense of different therapies being ineffective for them as an example. But then also additional trials are looking at combination of therapies, combination of biologics as an example. Because, again, this is perhaps where we're headed and to have clinical trials where we are looking at a P19 antibody and a TNF together, oh goodness, what's going to happen? Well, let's try it out. These trials are going to be very informative. Oral small molecules, the JAK inhibitors, that's in the pipeline to come for Crohn's disease as well. And I think again that's also exciting to see. And then also, there's newer therapies certainly in Phase 1, Phase 2 but antifibrotic therapies. Finally. And hopefully that will get to that next level as well.

David P. Hudesman, MD: And Dr Regueiro, with all these new therapies, what are still some of the unmet needs for our IBD patients?

Miguel Regueiro, MD, AGAF, FACG, FACP: I think some of them we talked about earlier is that kind of precision medicine biomarker, and the biggest unmet need is seeing remission rates that are consistently above 80%. We've continued to move the bar and we need to move it even more. Imagine a day when we're not talking about a 40% remission rate. We're talking about an 80% and we're getting smart about which treatment we're using first because we understand the biomarker, the makeup of that patient on a molecular basis. We're in the realm of looking at that. I think, again, thinking back 20 years to when anti-TNF started where we are today. I would say in the next 10 to 20 years that's possible and certainly before that we're going to see higher remission rates. We're already seeing that with our therapies. And then the other biggest unmet need and barrier, which we've talked about is just making sure the payers can also keep up with what is happening and making sure the education is there as well.

David P. Hudesman, MD: Yes, I agree, and I think what we've been seeing in our conference as well is access to care. So, access to care for all our IBD patients and all of our GI patients. It's been really nice going to these meetings now and seeing- showing some data about these access issues and how we address it.

Transcript Edited for Clarity