Proactive Care Is Essential for IBD Management

The focus of inflammatory bowel disease (IBD) management is moving away from classifying patients’ current disease severity. Instead, gastroenterologists are now zeroing in on assessing the patients’ future risk of developing a complication. This evolution from a treatment pyramid to a treat to target approach in IBD management was the keynote topic at the Advances in Inflammatory Bowel Disease (AIBD) Regional Meeting in Los Angeles.

Disease activity, phenotype, and risk are components practitioners are measuring in order to tailor treatment, according to meeting chair Gil Melmed, MD, who is co-director of the Inflammatory Bowel Disease Center at Cedars-Sinai Medical Center in Los Angeles. The selected initial therapy can then be adjusted until the pre-defined treatment target is met, he explained.

While a treat to target approach will increase the number of visits due to necessary close monitoring, the cost remains similar to a pyramid approach and is still within the range of the appropriate cost of effective outcomes. Still, cost, as well as formulary, access, and the risk of disease progression and therapy, should be considered when selecting the right management plan for a patient.

Further, the algorithm of care includes surgery, which should not be thought of as a personal failure. Instead, surgery should be viewed as an option that can alleviate complications and symptoms in order for the patient to achieve the best possible quality of life.

In order to successfully implement a treat to target algorithm of care into clinical practice, Melmed challenges practitioners to assess what percentage of their high-risk patients have an appointment scheduled in the next 3 months. Ensuring patients have a return visit scheduled can make sure the algorithm is effective and is an example of the proactive approach—rather than the reactive approach—for which the management strategy calls for. 

As IBD management evolves, so will the clinical trials. Combination drug trials should now be conducted rather than single-drug trials. Comparative effectiveness trials and algorithms of care trials will also be more widespread.

Ultimately, algorithms of care should be implemented in IBD management in order to provide a template for patient care, especially to optimize the patients’ window of opportunity.

—Colleen Murphy

Reference:

Melmed G. Evolution of disease management in IBD. Paper presented at: Advances in Inflammatory Bowel Disease Regionals. April 6, 2019; Los Angeles, CA.