Specialty Pharmacy’s Role in Advancing Treatments for Inflammatory Bowel Disease

Treatment for inflammatory bowel disease (IBD) varies based on each patient, but researchers recently spoke about how specialty pharmacists are key in identifying patients who would benefit from the utilization of advanced therapeutic options.

Rolf Benirschke, CEO of Legacy Health Strategies, San Diego, CA, and Christopher Owens, PharmD, MPH, assistant professor and interim dean at Idaho State University College of Pharmacy, Pocatello, ID, presented about specialty pharmacy’s role in advancing multidisciplinary approaches to managing IBD, a condition comprising Crohn’s Disease and ulcerative colitis.

Health care is constantly changing and with that, the role of the patient and physician are evolving. Mr Benirschke explained that physicians are no longer “the undisputed authority” as patients become more informed, connected, and have increased expectations.

Dr Owens said in the particular case of IBD, physicians should adhere to a shared decision-making process, which includes utilizing specialty pharmacists to help educate patients, facilitate adherence, choosing treatment options, and help navigate the process.

“According to 2015 estimates based on National Health Interview Survey data, 1.3% of US adults (3 million) reported being diagnoses with IBD,” Dr Owens shared. The disease, typically diagnosed between the ages of 20-40 years, can result in a series of complications including, fistula, strictures, hemorrhoids, and risks of cancer.

Dr Owens shared that typical patient assessment will reveal patient signs and symptoms, but a complete assessment utilizing specialty pharmacy may include biomarkers detectable in lab studies, imaging, and endoscopy.
Identifying biomarkers for IBD could help to rule out infectious and other potential causes, as well as better classify the severity of a patients’ disease, leading to more targeted treatment with potential cost savings.

For example, biologics have entered the market as a revolutionized treatment for IBD, targeting specific aspects of an individual’s immune response. This discovery has led to the first agents approved, TNF-alpha antibodies. “Additional agents have since been developed with other immune system targets: anti-adhesion molecules and anti-IL-12/23 antibodies.

The researchers noted that in 2009, “IBD hospitalizations resulted in 569,918 total hospital days, with a. mean cost of $32,965 and aggregate cost in excess of $1 billion.” Dr Owens continued, “In 2014, total direct [office visits, hospitalizations, surgery, and drug treatments] and indirect [quality of life reduction, work limitations, and increased sick leave] cost estimates indicate a range of between $14.6 and $31.6 billion.

There is no cure for IBD, however, there are a number of treatments that help managed and ensure patients live full and productive lives. Induction treatment options include, corticosteroids, aminosalicylates, biologics, and JAK inhibitors. Maintenance therapies also include aminosalicylates, biologics, and JAK inhibitors, with the addition of immunomodulators like methotrexate.

With so many varying options, the benefits specialty pharmacy offer are all the more crucial. “Specialty pharmacists are ideally suited to help with the coordination of IBD care, including medication access, patient education, vaccination, monitoring and refill management,” said Dr Owens.

—Edan Stanley