Novel Expert Perspectives in Treating Moderate-to-Severe Ulcerative Colitis - Episode 14
Experts in gastroenterology share take-home messages for the management of ulcerative colitis.
Miguel Regueiro, MD: Thanks, everybody, for this unbelievably rich and informative discussion. I always learn from the 3 of you, and I hope our colleagues will as well. We covered a lot in these segments, and each was important in terms of understanding how we treat IBD [inflammatory bowel disease], specifically how we got into the mechanism of action and treatments for ulcerative colitis [UC]. Before we end, I’d like to get 3 take-home points from each of you. Dave, I’ll start with you, and then Ellen and Marla. Dave, what are your 3 take-home points?
David P. Hudesman, MD: First is to treat early. Whether it’s a biologic or a small molecule, start treatment early. The second point is that we must monitor our patients—not just symptoms but biomarkers and endoscopy as well. Then third, for our targets, if we’re monitoring, is that perfect is the enemy of good. Getting better is OK, and we want to be discussing what the patient targets are as well.
Miguel Regueiro, MD: Ellen, your 3 take-home points?
Ellen J. Scherl, MD: We’re entering an era of disease modification, which means No. 1, get your patients off steroids. Think about a steroid exit as soon as you start the patient on it. A short course of steroids—don’t prolong mesalamines. Second, listen to your patients. What else are they doing? NSAIDs [nonsteroidal anti-inflammatory drugs], diet? Third, look to see that first-line treatments that do not have black-box warnings, that don’t have immunogenicity, but have both induction as well as persistence for disease modification. That would be vedolizumab, ozanimod, and ustekinumab, and don’t forget the JAK inhibitors.
Miguel Regueiro, MD: Marla, your 3 take-home points?
Marla Dubinsky, MD: First, we must understand what are the biggest fears that patients have about effective therapy. We must address them head-on or else—no matter how good our therapies are and how good we think we’re doing communicating that—we’re not going to be moving. That’s important in this era where we’re going to have new drugs every year coming out for the next few years. No. 2, quality of life as we define it is very different from how a patient defines it, so find out what keeps them up at night, what keeps them away from doing the things they most want to do. We have incredible therapies that can achieve disease modification, as Ellen said, but the key is to start it early. If you wait for a patient to develop progressive bowel wall damage, including in UC because we don’t talk about that enough, we’re not able to alter the natural history of these diseases.
Miguel Regueiro, MD: My 3 take-home points are: get it right in induction, listen to your patients, and treat the whole patient. We have great therapies, so let’s get smarter using them, but also consider relationships, work, school, psychosocial, and diets. Those are such important points.
I want to thank all 3 of you and our viewing audience. We hope you found this HCPLive® Peer Exchange discussion to be useful and informative. If you enjoy the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your in-box. Thanks very much. Dave, Ellen, and Marla, thanks for joining me.
Transcript Edited for Clarity