Miguel Regueiro, MD, on a Practical Approach to Positioning IBD Therapies

Dr Regueiro reviews the armamentarium of therapies available today for inflammatory bowel diseases and how best to position them to optimize outcomes among patients.

Miguel Regueiro, MD, is chair of the Digestive Disease & Surgery Institute at Cleveland Clinic in Cleveland, Ohio.

TRANSCRIPT:

I'm Dr. Miguel Reguero. I'm professor and chair of the Digestive Disease and Surgery Institute at Cleveland Clinic in Cleveland, Ohio. At AIBD 2022, we've had a great comeback year. We've had an equal attendance to what we saw prior to the pandemic in 2019, with a lot of enthusiasm and engagement.

In my keynote address at AIBD 2022, I discussed the positioning of advanced therapies in inflammatory bowel disease. Advanced therapies include biologics and also the oral small molecules, and my talk followed 4 other talks that really set up very nicely the medications that I discussed. And I think some of the take home messages for me are, in 80% of Crohn's and probably 40% of ulcerative colitis, we should start one of these advanced therapies right out of the gate, right after diagnosis. The second take home is that for ulcerative colitis and especially severe ulcerative colitis, probably infliximab and azathioprine in combination are still the best treatment, based on my opinion.

And if somebody fails that, upadacitinib, the Janus Kinase class, would be second. If they're not severe ulcerative colitis, then we have some other good options. Ustekinumab, vedolizumab, certainly the other anti-TNFs and JAK inhibitors. For Crohn's disease, perianal fistula, also, infliximab and azathioprine is my first choice, but also we have other options for Crohn's, such as risankizumab, which is the newest anti-IL-23, Ustekinumab as well. Plus obviously the anti-TNF therapies. So a lot of excitement on the positioning and how we use these treatments. I also covered safety in my new safety pyramid, looking at the different treatments of inflammatory bowel disease. Thank you.