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Treat-to-target approach shows benefits in IBD, but cost-effectiveness remains unclear
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LAS VEGAS — In this exclusive video from the Crohn’s & Colitis Congress, Peter D. R. Higgins, MD, PhD, of University of Michigan Internal Medicine, discusses his keynote presentation, which addressed two major topics in clinical IBD: the refractory patient, and raising the bar for outcomes.
Higgins offered three key points of advice for treating the refractory IBD patient: 1) make sure the flare is IBD; 2) treat infection first and then treat inflammation and structural damage; and 3) objectively measure inflammation and step up IBD therapy in a timely fashion.
Additionally, he argued the merits of raising the bar for remission in IBD, and discussed the need for future research to determine its cost-effectiveness.
“We talked about the concept of clinical remission ... and moving to validated biologic remission ... and showed the evidence that increasing biologic remission, using the biomarkers of control of disease, is actually really important, and patients in biologic remission have better outcomes than people in clinical remission,” Higgins said. “What we found was that as you go up the ladder of forms of remission, even histologic remission produces better outcomes than endoscopic remission. The question is how hard do we have to work to get there and how long will it take before the beneficial results appear.”
These benefits, he noted, have the biggest impact at years 3 to 5, in terms of reduced hospitalizations, surgeries, and other complicated outcomes.
“So, it appears that over time pushing to biologic remission really matters,” he said.
Additional questions include cost-effectiveness and the risks associated with therapy when getting a patient into deep remission, and further research is required to provide answers, he added.
“We feel that at this point in IBD there’s good evidence that treat-to-target can produce benefits, but the next step is proving that this approach is cost effective,” he said.
Reference:
Higgins PDR, et al. Keynote Clinical Presentation: Treating the Refractory Patient and the Rising Bar for IBD Outcomes. Presented at: Crohn’s & Colitis Congress; Jan. 19-20, 2018; Las Vegas, NV.
Disclosures: Higgins reports financial relationships with the Crohn’s & Colitis Foundation, AbbVie, Allergan, Amgen, Arena, Ascentage Pharma, Buhlmann, Eli Lilly, Genentech, GI Health Foundation, Janssen, Lycera, Medimmune, Nestle, Pfizer, Prime Medical Education, RedX Pharma, Seres, Shire, Takeda and UCB.