‘Fully utilize the various IBD treatment options available'

“It is important to make full use of the increasing options for Inflammatory Bowel Disease"

Hong Sub Lee. Professor at Busan Paik Hospital, “Preemptive treatment is necessary for high-risk groups."

IMD Clinic is open… will focus on fecal microbiota transplantation research

Professor Hong Sub Lee.

 

Busan Paik Hospital, Inje university.

Incidence of Inflammatory bowel disease (IBD), which had been regarded as a condition typically associated with Westerners, is now rising amongst Asian populations as well, including Koreans.

 

According to the IBD fact sheet published by the Korean Association for the Study of Intestinal Diseases, the number of patients with ulcerative colitis and Crohn's disease has more than doubled in 10 years, to 37,000 and 18,000, respectively, by 2019.

 

At the same time, treatments that can be used as a "weapon" by doctors are being introduced competitively to the market are being launched competitively.

 

In an interview with Dailypharm, Professor Hong Sub Lee (Department of Gastroenterology) of Busan Paik Hospital, Inje University, assessed the importance of 'sequencing' the existing and new drugs and preparing an IBD treatment strategy customized for each patient.

 

In recent years, appropriate drug selection has emerged as a key issue in the treatment of IBD in clinical practice in Korea, as treatment options have diversified to include Janus kinase (JAK) inhibitors in addition to conventional biologics.

 

While it is not always possible to immediately switch to another drug when the therapeutic effect of a drug is inadequate, the availability of several prescribable options has created a dilemma of which drugs to use and in what order.

 

Professor Lee explained, "We divide patients into low-risk and high-risk groups according to the presence and severity of symptoms, and then develop a treatment strategy and select drugs accordingly.” Lee added, "High-risk patients are those who are younger, have lesions that invade the entire large intestine and have deep ulcers.

 

They are considered high-risk patients according to IBD metrics, in which case they are judged to be candidates for biologics or small molecule drugs that have recently been introduced in Korea." "We approach patients with fewer symptoms with the usual treatment strategy.

 

But high-risk patients need to start a treatment sequence in line with the health insurance reimbursement system as quickly as possible." Adding to the dilemma for clinicians is the recent increase in the use of JAK inhibitors as a mainstream treatment option for ulcerative colitis and Crohn's disease.

 

"Recently, JAK inhibitors have also been increasingly used to treat IBD.

 

For example, filgotinib is the only JAK inhibitor that can be prescribed directly after azathioprine.

 

According to clinical trials, upadacitinib has shown a high effect.

 

However, to prescribe other JAK inhibitors, you need to first take patients off azathioprine, which is problematic for doctors because they have to remove a drug that they believe is effective for their patients." Therefore, Professor Lee believes that Korea’s reimbursement standards need to be improved to allow for more freedom of choice in clinical practice.

 

"I would like to be able to quickly prescribe the increasing number of drug options to patients who really need them.

 

We don't need to wield a big knife for patients with mild symptoms, but we need to improve the reimbursement standards so that we can approach each patient especially those at high risk with a personalized treatment strategy so that we can actively use necessary drugs.” "In addition to drugs, fecal microbiota transplantation (FMT), which utilizes the gut microbiome to treat IBD, is a major therapeutic option.

 

I opened an inflammatory bowel disease clinic last November and am looking to start a gut microbiota transplantation company and pursue its research.

 

I want to research and develop therapies using FMT to help treat IBD in practice."