VIDEO: Personalizing treatments for ulcerative colitis

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When you have sort of choices which we haven't had in a while. You know, we started way back, it was an IV, and then it was maybe a Sub-Q of the same class, and then it was, oh, there was a new class in 2014 still given intravenously. And sort of it went on, and I remember as the oral small molecules came out with Tofacitinib being the first really approved oral small molecule, we were like, oh my God, we have the first pill for IBD.

And so now we have, do you want an IV? Do you want oral? Do you want self-injectable? Do you want a self-injectable every two weeks? Do you want it every four? Do you want it every six, eight? So there's a lot of options. So I think what it comes down to is one of the things that I think my colleagues and I do struggle with is that even though a drug is approved for a certain indication, they exclude many of the patients that are sitting in front of you the day after the drug is approved. They have no data on pregnancy.

They don't have pediatric data. They had a small amount of patients who maybe have been over the age of 65 and/or they didn't have surgical resection candidates or they didn't have someone with long upper-track Crohn's disease. I mean, everything gets thrown out the window when you're sitting in front of the patient the day that the drug is, you know, you can prescribe it. So I think one of the things that matters is that you really need to look at what are the barriers to the patient adapting or adopting this therapy? Is it for fear of safety? Is it for fear of adherence? Is it misinformation, or they want some clarification of some of the commercials that they've heard some safety on certain things?

Again, I think patients are really focused on they want to feel better, but they also want to not have a serious adverse event that they may have heard about either through a relationship or a friend or somebody that they know, or on the internet, or on the package insert or the commercials. And I think recognizing that safety and convenience are important, but I think what we need to do a better job of is other than, yes, this drug is approved, so it meant it was effective, how do we ensure that we're matching the right therapy for the right patient?

And I think understanding what are the risk factors of the disease inherent to the condition itself, even though a patient may prefer a pill or may prefer an IV or a self-injectable, if that is not the best option for the specific patient sitting in front of you, you sorta have to reframe the way you communicate around what would be the best option for the person sitting in front of you.