‘Various treatment options emerged for ulcerative colitis'

but the patients are restricted access

Tae Oh Kim, Professor of Gastroenterology, Inje University Haeundae Paik Hospital

New drugs such as biologics and JAK inhibitors have emerged, but prescriptions are limited

“Patients have difficulty receiving a single treatment for a long period of time...Patients need to have access to various drug options.”

Tae Oh Kim, Professor of Gastroenterology, Inje University Haeundae Paik Hospital

“Various treatment options such as biologics and JAK inhibitors have emerged for ulcerative colitis, but the patients’ options are limited because the government does not allow switching between drugs.

 

Especially as the number of young patients in their 20s and 30s and their life expectancy is both increasing, securing various treatment options for these patients has become the more important.” Tae Oh Kim, Professor of Gastroenterology at Inje University Haeundae Paik Hospital explained so in a recent interview with Dailypharm regarding Korea’s ulcerative colitis treatment landscape.

 

  Ulcerative colitis is a chronic inflammatory growth disease of an unknown cause characterized by inflammation localized in the mucosal or submucosal layer of the large intestine.

 

Due to the nature of ulcerative colitis, which is characterized by flare-ups and exacerbations and a varying clinical course, consistent medication is currently regarded as the only treatment option for affected patients.

 

The good news is that there are many different treatment options available for the disease.

 

There are several treatment options available for ulcerative colitis, including anti-inflammatory drugs, corticosteroids, immunomodulators, antibiotics, biologics, Janus kinase (JAK) inhibitors, and S1P receptor modulators.

 

Kim said, “While many of these treatments have proven clinically effective, the patients we see in practice have different comorbidities, ages, etc.

 

Therefore, we can't use the therapies based on clinical data alone,” said Dr.

 

Kim.

 

“We need to try drugs that are not only effective but also safe, but the current prescription standards for ulcerative colitis in Korea do not allow for effective treatment,” he added.

 

Increased patients' life expectancy...“Various treatment options should be secured” According to the Health Insurance Review and Assessment Service, the number of patients with ulcerative colitis and Crohn's disease in Korea increased by 32% from 67,741 in 2017 to 80,289 in 2021.

 

The prevalence of younger patients, especially those in their teens to 20s, has increased significantly due to Westernized eating habits.

 

“As the life expectancy of the patients increased to 80-90 years, the more treatment options we have, the better,” said Kim.

 

“However, all drugs lose their effectiveness over time.

 

In the case of TNF alpha inhibitors, patients develop antibodies in the body, making it difficult to continue the use of the drug.: “We use drugs even if they are only 30% effective, and some patients do not respond to the drug from the beginning.

 

However, due to the limitations of Korea’s insurance reimbursement system, we have to continue administering the ineffective drug to these patients.” In ulcerative colitis, switching between JAK inhibitors is not allowed in Korea.

 

Korea’s insurance reimbursement standards allow patients to use steroids or immunosuppressants first, then switch to other therapies if they don't work.

 

Biologics or JAK inhibitors can only then be used, but if a patient switches from one treatment to another, he or she cannot go back to the previous therapy.

 

JAK inhibitors cannot be cross-administered.

 

This is why the patients’ options are rather limited despite the many treatment options on the market.

 

While developers have supported the use of various medications with efficacy and safety clinical data on switching, overseas cases, and accumulation of real-world data, the regulatory authorities have disallowed switching in ulcerative colitis, citing a lack of clinical evidence.

 

“Some treatments have shown strengths in efficacy, such as Rinvoq, and others are strong in safety, such as Jyseleca,” said Kim.

 

“However, I think it is problematic that we are not able to try new drugs due to Korea’s restrictive treatment selection standards.

 

We should be allowed to switch drugs and then go back if the new option doesn't work for the patient.

 

We may not have known enough about the effectiveness of the previous drug because it was used for a short period of time.” “Oral agents, such as JAK inhibitors and TYK2 inhibitors, have the advantage of not developing antibodies.

 

It is important to increase patient access to a range of oral treatment options in addition to injectables, as antibodies can lead to loss of response.

 

Some patients do not respond to any treatment.

 

There is no set treatment sequence for ulcerative colitis and as patient characteristics also vary, it is important to have multiple treatment options available.”