Assessing the Role of Immunomodulators in IBD

Announcer:
Welcome to Crohn’s & Colitis Foundation Perspectives on ReachMD. Here’s your host, Dr.Charles Turck.

Dr. Turck:
This is Dr. Charles Turck from ReachMD here talking to several faculty from the upcoming Crohn’s and Colitis Congress, a partnership of the Crohn’s and Colitis Foundation and the American Gastroenterological Association. Joining me to talk about some of the highlights from her upcoming presentation at the congress is Dr. Maria Oliva-Hemker from Johns Hopkins University School of Medicine. Dr. Oliva-Hemker, it’s good to have you with us.

Dr. Oliva-Hemker:
Thank you. It’s great to be with you.

Dr. Turck:
So, you’ll be speaking on where immunomodulators fit into current treatment approaches at the congress and I’d love to hear a quick overview of the topics you’ll cover during your presentation.

Dr. Oliva-Hemker:
Well, let me start by saying a couple of things. First of all, compared to adult IBD, pediatric IBD presents with a more severe and aggressive phenotype and it has unique complications, which include growth impairment and pubertal delay. And over the last two decades, there has been increasing evidence that early treatment with anti-TNF’s is superior to early treatment with immunomodulators. And now with new classes with biologics and small molecules entering the market, the place for immunomodulators in the treatment of pediatric IBD is really being questioned. In fact, it’s become a bit of a controversial topic that can bring out passionate responses in many. But I hope to approach it with a measured response. So, I plan to cover three topics in my talk. First, to identify which patients with Crohn’s disease and ulcerative colitis will benefit from immunomodulator monotherapy and again by immunomodulators we’re talking about methotrexate and the thiopurines, azathioprine, and 6-mercaptopurine, and then second, to discuss how immunomodulators are used in combo therapy, specifically with anti-TNF agents. And then finally, I want to review the risks associated with immunomodulator therapy. We know that IBD is a lifelong condition, and so children will require many more years of immunosuppression, so it’s important to approach the topic of risk with the concept of shared decision-making in mind.

Dr. Turck:
And what do you feel will be the key takeaway from your presentation?

Dr. Oliva-Hemker:
Well, I think a key takeaway from my presentation will be that there is still a role for immunomodulator monotherapy in the management of pediatric IBD, albeit, a limited role. And also that for now, the use of concomitant immunomodulators is well-established in anti-TNF therapy, you know, to increase anti-TNF blood levels and reduce immunogenicity; however, increasing evidence suggests that anti-TNF monotherapy optimized with therapeutic drug monitoring can be just as efficacious as combo therapy and certainly with children, we want to minimize medication burden, so I think it’s remains to be seen whether the use of combo therapy will be diminishing in the coming years.

Dr. Turck:
Now, from your perspective how might your peers best incorporate what they’ll learn from your presentation into practice?

Dr. Oliva-Hemker:
In my talk, I will include slides that provide practical guidance that can be used as a checklist in terms of screening and dosing and monitoring that I hope clinicians will find useful when they prescribe immunomodulator therapy. And I really hope that my talk encourages clinicians to go back to their practice and apply to their patients that are receiving immunomodulators the same treatment targets that we apply to patients on biologics. In other words, not just trying to achieve symptomatic relief, but to ensure that there is appropriate growth, that there is normalization of biochemical markers, and that there is tight control of inflammation, including mucosal peeling.

Dr. Turck:
Well thank you so much for taking the time to speak with us today and we’re eager to hear your presentation and other great content from the 2021 Crohn’s and Colitis Congress, taking place January 21st through 24th. Learn more about this and other presentations at www.crohnscolitiscongress.org. I’m Dr. Charles Turck with ReachMD. Thank you for joining us.

Announcer:
This episode was brought to you in collaboration with the Crohn’s & Colitis Foundation and the American Gastroenterological Association. To learn more about the Crohn's & Colitis Congress, please visit crohnscolitiscongress.org. Thanks for listening!