VIDEO: Integrating personalized medicine into ulcerative colitis treatment plans

Editor’s note: This is an automatically generated transcript, which has been slightly edited for clarity. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription

With so many different therapies with different mechanisms of action, the big question is what treatment is the right treatment for the patient sitting in front of me in clinic? It is really important to take into account many factors in our decision, beyond the simple diagnosis of ulcerative colitis. What is the extent of the disease? What is the disease activity, meaning what are the current symptoms of the patient, what is going on in their colon, what is their Mayo score? What is the disease severity, which means how the disease has been behaving since diagnosis? Did this patient need multiple hospitalizations? Is the disease progressing in extent or severity? Looking really at the disease activity and severity, prior treatment response or lack of response. But also beyond what’s going on in the GI tract, it’s important to see whether or not the patient has extraintestinal manifestations or associated conditions that would also respond to specific mechanisms of action.

For example, if you have a patient with UC and ankylosing spondylitis, this patient would benefit best from anti-TNF or a JAK inhibitor. If we have a patient with UC and psoriasis or psoriatic arthritis, we have to think about IL-12/IL-23 or IL-23. It’s important to, again, look at the patient beyond the GI tract, and think what other symptoms or conditions are associated with their UC that can also benefit from the therapy.

But also it’s important to look at comorbidities, conditions that would put the patient at higher risk for specific side effect of a therapy. Patients at very high-risk of infection, the elderly, patients who are frail, patients who are already on immunosuppression, they would be at higher risk of infection with anti-TNF. A patient who traveled to endemic areas of tuberculosis would be at higher risk with an anti-TNF. On the other hand, patients who maybe have active disease that puts them at high risk of a thromboembolic event, either they have a hypercoagulable state or a genetic disease that put them at high-risk of DVT, these are the patient where a JAK inhibitor might not be ideal and put them at high-risk. It’s important to look at the other medical conditions of that patient.

And finally, talk about to patients about their lifestyle and their jobs and what do they do for a living, or how do they live? Are these big travelers or does their job require them to travel? Do they have access to an IV infusion center? Really to use drugs that are effective, but also that are in line with what the patient can have access to and the patient preference to infusion injection or oral medication. And finally, in a young woman, it’s important to ask about pregnancy planning, because biologics are safe during pregnancy and breastfeeding. However, small molecules, JAK inhibitors and S1PR modulators are not safe during pregnancy and breastfeeding. So if a young woman has any pregnancy plan in the next few years, the choice of therapy needs to take that into account.