Multidisciplinary care teams ‘critical’ for the treatment of very early-onset IBD
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LAS VEGAS — Collaborative, multidisciplinary care strategies optimize the treatment and management of patients with very early-onset inflammatory bowel disease, a presenter reported at the Crohn’s & Colitis Congress.
“There are some important distinctions here [among patients who present with very early-onset IBD] ... but as a whole this disease is quite heterogeneous and diverse,” Judith R. Kelsen, MD, director of the Very Early Onset Inflammatory Bowel Disease Clinic at Children’s Hospital of Pennsylvania, said. “There are some patients whose disease can be mild or ... respond similarly as older children with IBD, but then there’s a distinct population of patients whose disease might look very different from the outset and might be more refractory to conventional therapies.”
She continued: “We’re also seeing a rapid rise in incidence in all ages.”
An important consideration when diagnosing and treating very early-onset IBD (VEO-IBD) is whether a patient’s disease is polygenic or monogenic, Kelsen said. While polygenic disease can easily be explained by factors such as the environment, microbiome or diet, monogenic disease is caused by rare or novel IBD variants.
Once monogenic disease is detected, the next step in evaluation is to identify those who may benefit from targeted therapy and those who are at risk for non-gastrointestinal complications such as malignancy, sepsis or septic shock.
Patient care, plan of action
Though initial evaluation of VEO-IBD can often be straightforward, challenges can arise when providing optimal care for this patient population. According to Kelsen, limited resources, such as the availability of studies and clinical validation, as well as the need for expertise are among challenges encountered.
“Having that expertise with you to make those [treatment] decisions is critical with how to translate all this data into a therapy plan,” Kelsen said. “The benefits of having a team that is a multidisciplinary team really, I think, speaks for itself. Having diverse expertise that can work together can radically change the way we care for patients and provide that best tactical care.”
Kelsen also recommended identifying unique phenotypic patterns at baseline; strategies include evaluation of growth failure or stunting, endoscopic and histologic patterns, immunoglobins, vaccine titers and a cytokine panel. Therapeutic considerations for this population include neutrophilic infiltrates, lymphocytic predominance regulatory or adaptive immunity defects, B-cell defects and hyper/auto inflammatory.
“I think the unique factor of very early-onset is the critical nature of multidisciplinary teams and synergy of care, where we combine critical data points with translational data points to optimize care,” Kelsen concluded. “Each patient is very different but, working together collaboratively, through different research pipelines and different clinical pipelines, can optimize care.”
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Kelsen JR. Very early onset inflammatory bowel disease: Where to start and when to refer. Presented at: Crohn’s & Colitis Congress; Jan. 25-27, 2024; Las Vegas.
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