Best Practices in the Management of IBD During COVID-19 - Episode 10

Inflammatory Bowel Disease: Limitations in Treatment

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Miguel Regueiro, MD: Jean-Fred, I’ll come back to you to ask a horizonal question. You mentioned a minute ago that there is a gap in care for IBD [inflammatory bowel disease]. My opinion is that they are not getting that 80% to 90% remission. We may see that oncology has advanced to a point where they’re understanding on a mechanistic level how to treat more precisely. Where do you think the IBD field is going? Where do you think the gaps are? I know that’s a lecture unto itself, but in a few minutes, tell us your thoughts.

Jean-Frederic Colombel, MD: There are several points. The first is how we can go from this 50% to 40% maintenance to 60%, and it is the same for induction: from 20 to 40%. I’m talking about remission. We have been working on that for years, Doug and Miguel. We are all talking about precision medicine and finding the predictors of response. Unfortunately, a lot of money has been invested, but so far there is nothing. There are some data but no practical tools that we can apply at the bedside for our patients. We should continue toward precision medicine as in oncology, but it’s not an easy task.

Imagine that for anti–TNF [tumor necrosis factor] agents, we have no good predictors, even for the oldest agent. I believe in this concept of combination, which could make sense: combine 2 mechanisms of action. We should base this combination on mechanistic data rather than just humdrum. The big question then is that patients like to ask about a cure, which is a different story because even though we are able to bring those patients into the deepest level of remission, clinical endoscopy, histologic measures, or cross-sectional imaging in Crohn disease show that if you stop—which would be the curative approach—the risk of relapse up to now, even in early patients, is almost 50%. It’s not a cure. We can control, and we can maintain, but we can’t cure. This is another topic, but I believe the cure is in the preclinical phase where you can catch the disease before the first symptoms, so it is a prevention strategy. This is for another day.

Miguel Regueiro, MD: I think you’re right. You’ve done some interesting studies from a collection of serum samples years ago finding changes that probably predicted IBD in the future. It’s a very futuristic look, so I applaud you for that.

Transcript Edited for Clarity