What you learned last year about the treatment of IBD is already out of date.
New biologics, approved by the U.S. Food and Drug Administration, that do not block TNF are coming, as are biosimilars for anti-TNF agents. Meanwhile, new data are pointing the way toward novel treatment strategies, and small molecules promise to push even the newest biologics to the back of the treatment pack.
The latest advances in IBD treatment will be reviewed Tuesday during the annual Farron and Martin Brotman, MD, Lecture. The AGA Clinical Symposium is titled The Modern Medical Management of IBD: Biologics, Biosimilars and Small Molecules.
“So many things are happening in IBD right now that it’s difficult for clinicians to keep up,” said Maria T. Abreu, MD, AGAF, director of the Crohn’s & Colitis Center, the Martin Kalser chair in gastroenterology and professor of medicine and microbiology and immunology at the University of Miami Miller School of Medicine, FL. “Every gastroenterologist who sees IBD patients needs to be conversant about these new data and new treatments. Even if you are not prescribing them, your patients will be asking about them.”
Dr. Abreu will co-moderate the session, which is intended to help clinicians select the most appropriate biologic for IBD patients, integrate biosimilars into their practice and assess the role of new, non-biologic therapies for IBD.
Vedolizumab and ustekinumab, two agents introduced in 2016 that do not block TNF, changed the treatment paradigm, Dr. Abreu said. A growing body of data suggests that patients who switch from an anti-TNF agent to another class of biologic do not do as well as patients who started on the new biologic as first-line therapy.
“A lot of lip service has been paid to this being a more refractory group of patients or a group of patients who have had IBD longer and have progressed to more severe disease,” Dr. Abreu said. “The other emerging possibility is that we ought to consider using other biologics that are not anti-TNFs as first-line agents.”
The introduction of biosimilar versions of familiar anti-TNF agents in the U.S. poses more questions. These agents are similar to the original biologic, but they are not identical. There’s at least the potential for changes in therapeutic effect and adverse events when switching between an originator biologic and its biosimilar.
“Europe has had access to biosimilars for both infliximab and adalimumab for several years,” Dr. Abreu said. “Biosimilars are a very big deal in terms of cost. In this session, we will take a firsthand look at the clinical experience in switching patients between the original biologic and the biosimilar.”
The increasing use of small-molecule drugs for IBD will also be explored during the session. While there are no small-molecule agents for IBD approved by the FDA, agents such as tofacitinib, which is approved for rheumatoid arthritis, are under study. Tofacitinib inhibits JAK1 and JAK3, which are involved in the downstream signaling of a variety of inflammatory cytokines, Dr. Abreu explained.
“One of the most immediate advantages of small-molecule drugs is oral dosing, which could be a huge step forward for patients,” she said. “A second key advantage is the lack of immunogenicity. Small-molecule agents do not promote the development of antibodies that can interfere with treatment.”
Please refer to the DDW Mobile App or the Program section in Tuesday’s DDW Daily News for the time and location of this and other DDW® events.
Martin Brotman, MD, AGAF, and Farron Brotman
Why is the clinical symposium important?
Dr. Brotman: The medical management of IBD has changed rapidly over the past few years. Improved understanding of the underlying pathogenetic mechanisms has stimulated development and clinical trials of a host of new drugs. It’s essential that clinicians be kept up-to-date on how to best integrate these advances into their patient care. The data to be presented by the distinguished panel of experts at this clinical symposium will define the current state of our knowledge in this rapidly evolving field.
What does it mean for you to support the AGA Research Foundation through a clinical symposium?
Dr. Brotman: I have been dedicated to supporting research in gastroenterology throughout my career. As a clinical practitioner, I have benefited daily — as have my patients — from the knowledge developed and disseminated by basic, translational and clinical researchers. Farron and I were pleased to have the opportunity to give back by making a gift to the AGA Research Foundation to support its vitally important programs that fund investigators at a critical time in their careers. We are honored to have our names associated with a state-of-the-art education symposium in an area of gastroenterology that was a major interest of mine throughout my years in practice. The new knowledge to be presented in this symposium is testimony to the importance of research funding.
AGA is grateful to its donors for their generous contributions, which go directly to the AGA Research Foundation awards program endowment to support future research that will lead to improved patient care.
It is stated that tofacitinib is still under study.That is not accurate. It was approved in May 2018 for UC.
This is a glaring error.