Christina Ha, MD, on “Outside the Box” Therapeutic Options for IBD

In this video, Dr Ha discusses some new and upcoming alternatives for managing inflammatory bowel diseases, a topic she presented on at the recent virtual AIBD regional meeting.

Christina Ha, MD, is a gastroenterologist with the IBD Center at Cedars-Sinai in Los Angeles, California.

TRANSCRIPT:

Dr Christina Ha: Hi, my name is Christina Ha. I'm part of the inflammatory bowel disease center at Cedars-Sinai. I gave a talk that's called "Outside the Box Therapies." The key points from those talks were to really identify 4 key areas of exploration to maybe consider in the future for some of your patients.

The first one is flipping the script and thinking about maybe positioning surgery first and medication second for some select groups of patients, particularly with Crohn's disease. Patients with, let's say, deep ileal ulcers or strictures or fistulas, abscesses at the time of presentation.

The goal here is to identify what treatment strategy is going to get your patient into remission the most successfully and durably. Then what strategy is most likely to maintain remission? Sometimes, that may actually be surgery first. You have your whole arsenal of medications to use once they're in a surgically-induced remission.

Another strategy that's gaining some interest but still needs some more exploration is hyperbaric oxygen. There are some preliminary data using it for severe ulcerative colitis with some very interesting and successful outcomes. But there may be some roles of using hyperbaric oxygen for other aspects of IBD care, such as perianal Crohn's disease, pyoderma, or potentially ischemic strictures.

Then we also talked a bit about combination therapies, particularly combinations with different biologics or biologics plus small molecules. This is gaining a lot of interest because a lot of our medications aren't very successful at durably maintaining remission over time. So what if we combined two agents?

Some of the key aspects of the thought process when we're thinking about using combinations of biologics or biologics and small molecules is what does their history tell you about their future? Did they use these medications successfully in the past and just simply lost response? Or did they never respond?

Is their treatment history such that surgery may be beneficial first and then reintroduction of a prior medication later? But if they've never been on an agent before, perhaps that combination may be successful, although we still need to further investigate this.

Finally, we talked about clinical trials. Oftentimes, we think of clinical trials as a last resort for our IBD patients.

However, staying abreast of the latest literature about the mechanisms of action that are out there and counseling our patients about good studies that are potentially available for them early on may actually increase patient satisfaction, patient confidence in clinical trials, but also provide a very good option that has the built-in continued monitoring for your patients before it's too late.