Open communication, not waiting key for identifying ‘right treatment’ in UC
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LAS VEGAS – Physicians should remember there are many points to consider when selecting the right treatment for patients with ulcerative colitis, according to a presenter at the ACG Annual Scientific Meeting.
“When selecting the right treatment for the right patient with ulcerative colitis, we need to consider that there are at least three stakeholders in every decision: We have the patient, the provider and the payers,” Corey A. Siegel, MD, MS, of the Geisel School of Medicine at Dartmouth, said during a presentation.
Past treatment strategies have tried to place patients in a “bottom-us vs. top-down” mold, but clinical innovation and evolving treatment approaches have allowed personalized decision-making based on a number of factors, including current disease activity and severity, treatment efficacy and payer preference, Siegel said.
Points to consider when selecting a treatment plan for patients with UC:
There is no one correct “order” for treatment; rather, what matters most, is what the patient wishes to accomplish. For some patients, speed may be their priority, whereas another may prioritize treatment with more robust safety data available. Open communication between patient and provider is of utmost importance.
Infliximab (Remicade, Janssen) is the most effective treatment strategy for biologic-naive patients, but ustekinumab (Stelara, Janssen) and tofacitinib (Xeljanz, Pfizer) are most effective for patients who previously failed anti-tumor necrosis factor therapy. Siegel said vedolizumab (Entyvio, Takeda) continues to appear safe without hurting the chances of infliximab working as a second-line treatment option.
No treatments are a “slam dunk” pick compared with others the first time around, and prolonged administration with the idea of picking the exact “right treatment” is often the most harmful course of action for patients.
Though advocating for patients is important, fighting against payers for first-choice treatment is only worth it sometimes.
“Just starting medication and getting our patients feeling better is the goal,” Siegel said.
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Siegel C. Ulcerative colitis: Right patient, right therapy. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
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