Corey Siegel, MD, on New and Future Friends in IBD Treatment

Dr Siegel gives highlights of his presentation at the Advances in Inflammatory Bowel Diseases regional meeting on new medications for inflammatory bowel disease and therapies on the horizon that could offer exciting new options.

Corey Siegel, MD, is section chief of gastroenterology and hepatology at the Dartmouth-Hitchcock Medical Center and professor of medicine at the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire.

TRANSCRIPT:

Hello, I'm Dr. Corey Siegel. I'm the section chief of Gastroenterology and Hepatology at the Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, and a professor of medicine at the Geisel School of Medicine at Dartmouth.

At AIBD Regional today, I talked about new and future friends. This was about our new drugs that we currently have available with us for inflammatory bowel disease treatment and medications that are on the horizon with some exciting new mechanisms.

The reason we need to do this is we don't have this solved. We have great medications for the treatment of IBD, but we are certainly not achieving the rates of mucosal and histologic healing that we'd like, and also we need more choices and new mechanisms for patients. We need to be creative in the way that we're thinking.

The first drug class I talked about were the S1P receptor modulators. This drug, now on the market, ozanimod, has been successful in phase 3 trials and is now available for patients with ulcerative colitis and still in clinical trial for patients with Crohn's disease.

The TrueNorth studies showed statistically significant improvements in efficacy for both clinical remission and endoscopic healing and a great safety profile of these medications.

There are other medications in this class coming. We focused a bit more on ozanimod since it's here, but we also talked about etrasimod, which is another medication that's probably on the horizon.

We shifted then to new mechanisms that aren't quite ready for primetime and still in earlier phase clinical trials. The first one we discussed was a TL1A mechanism. The reason TL1A is very exciting is it appears to treat both inflammation and fibrosis or scarring. If this works as we hope it does, it will not only treat the inflammatory effects of IBD, but also either prevent or reverse fibrosis, which can be a huge step forward, both through the treatment of Crohn's disease and also for ulcerative colitis.

There's a proof of mechanism study that showed that it likely works. Currently being developed are more precision medicine techniques to identify which patients may or may not respond to this mechanism so that we can focus our treatments where it might work even more effectively than others. Again, an exciting time and new mechanism and also an advancement in precision medicine.

We then turn to stem cells to treat Crohn's perianal fistula. Stem cells have been talked about for a number of years in IBD, but we do appear to have an effective treatment now with some early phase studies showing that injecting stem cells into fistula tracts may help heal those fistulas and prevent trouble in the future. More work to be done here. Again, an exciting time with the new mechanism.

Then finally, I touched on a new, completely different mechanism to prevent post‑operative recurrence of Crohn's disease going after something called the FimH host receptor. What this is doing is binding to bacteria that we believe creates an inflammatory process deeper in the mucosa. If we can prevent these bacteria from burrowing their way into the bowel wall and causing an inflammatory response, then we may have an opportunity to prevent recurrence after surgery. These are all in clinical trials now. We'll see where things go.

In summary, there's a lot going on in IBD research. There are different mechanisms, different targets, and at different stages of development. The S1P modulators have arrived, at least for ulcerative colitis, and we'll see where things go for Crohn's disease. Then many other biologic and nonbiologic treatments are coming in the future.

An exciting time for new things coming, exciting time for new things that have already arrived, and we look forward to where these are going in the future. Thank you.