ReachMD

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

Dr. Turck:
From ReachMD, I’m Dr. Charles Turck.  And here with me today to share key takeaways from the Fifth Annual Crohn’s & Colitis Congress, which is a partnership of the Crohn’s & Colitis Foundation and the American Gastroenterological Association, is Dr. Peter D. Higgins.  Along with being the 2023 Crohn’s & Colitis Congress Chair, he’s also a Professor of Medicine at the University of Michigan. 

Dr. Higgins, thanks so much for being here today. 

Dr. Higgins:
Thank you for inviting me. 

Dr. Turck:
Now, Dr. Higgins, you served as cochair for the 2022 conference.  So with that in mind, what was most compelling about the sessions you were able to join? 

Dr. Higgins:
I think the breadth of approaches to improving the care of IBD patients, not only medications and surgery, which are our traditional approaches, but addressing the biopsychosocial issues--the anxiety, the depression, the PTSD that patients are experiencing, addressing concerns about diet and trying to reach patients where they are, particularly during the pandemic.  Immunosuppressed patients are incredibly stressed and addressing those issues with specially-trained GI psychologists who are doing studies and really developing a new understanding of the global effects of having IBD on patients’ lives, including anxiety, depression, and dealing with the risks of infection when one is immunosuppressed. 

Dr. Turck:
And based on the sessions you attended, what would you say you’d like medical professionals to start incorporating into their clinical practices? 

Dr. Higgins:
I think the biggest thing in the short term is addressing inflammation broadly and using objective measures of inflammation to identify whether a treatment is effective and will be effective long-term.  We have compelling data that if we can control inflammation, it not only controls symptoms now but is predictive of long-term control of symptoms, and that’s really the long-term goal for us in a chronic disease like Crohn’s disease or ulcerative colitis is long-term control of symptoms.  And the best predictor of that is not necessarily symptoms today but control of inflammation today. 

Dr. Turck:
Were there any posters or oral abstracts that stood out to you or those that you would recommend your colleagues check out on demand? 

Dr. Higgins:
I think some of the most compelling content was Jean-Frederic Colombel’s keynote, “Breaking the Ceiling of IBD Therapies,” and the problem of getting past the 50‒60% response rate we’re getting with most therapies, and we’ve sort of been stuck there the last 5 years. There’s a session on precision medicine and a session on technology.  But I think this is a really exciting area, and we’ve seen recently that upadacitinib, a new medication for ulcerative colitis, is breaking through that glass ceiling of 60% response in ulcerative colitis and is looking like a very promising medication.  So that’s one approach.  Another approach that was really interesting—and this was recently presented at ECCO, and you’ll probably see more of this—is the VEGA study, which combined therapy between guselkumab and golimumab.  In the first 12 weeks in ulcerative colitis, they were able to get a response rate of 83.1%, which is quite a bit higher than the 60% that we’re used to seeing, so a lot of compelling data and a lot of hope for breaking that therapeutic ceiling in the next couple of years. 

Dr. Turck:
And before we close, Dr. Higgins, I stated when introducing you that you’ll be serving as the 2023 Crohn’s & Colitis Congress Chair.  So what can you tell us about the 2023 program so far?  And are there any themes or topics you’d like to see included? 

Dr. Higgins:
A lot of this at the moment is in the brainstorming phase, but I think we are hoping to include a session on future approaches to IBD.  And it’s a little bit speculative, but we’ve seen that there may be important roles of viruses in inducing autoimmune diseases.  A recent paper showed that EBV infection precedes the onset of multiple sclerosis, and the use of rotavirus vaccines in children in Australia has significantly reduced the rate of type 1 diabetes a few years later, so it’s possible that other autoimmune diseases, including IBD, may have an induction phase where viruses play a role.  And as we learned with COVID, there are a lot of viruses out there that we don’t know about, so I think that’s going to be an important area of study in the next 10 years. 

I think there’s a lot going on in studying prevention of IBD by intervening on pre-IBD states.  The GEM study has shown that first-degree relatives of patients with IBD have what’s called leaky gut as defined by lactulose:mannitol absorption.  And could we intervene on these folks who have just really pre-inflammation, don’t have symptoms, are not diagnosed, but there’s something not quite right about the integrity of their intestinal wall?  And is there a way to intervene to possibly prevent IBD in these people?  And then the potential, and this is a reach, of gene therapy.  We’ve seen really dramatic results in the last few years with sickle cell therapy where intervening on sickle cell can dramatically change the course of a patient to the point that they’re not getting transfusions; they’re not getting admitted to the hospital for pain crises.  And the most common gene would be NAN2.  And is there potential to intervene with CRISPR therapy, as has been done with sickle cell, for the 40% of Crohn’s patients who have an abnormal copy of the NAN2 gene and possibly for a large percent of patients change the course of IBD.

Dr. Turck:
Well, I very much look forward to seeing what the 2023 Crohn’s & Colitis Congress will have to offer.  But for now, I want to thank Dr. Peter D. Higgins for joining me to share highlights from the 2022 Congress.  Dr. Higgins, it was great having you with us. 

Dr. Higgins:
Thank you. 

Dr. Turck:
For ReachMD, I’m Dr. Charles Turck.  If you couldn’t join the sessions live, all Congress content is available on demand through December 31, 2022.  Find out more by visiting CrohnsColitisCongress.org.  Thanks for tuning in.

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