Looking at the Big Picture of IBD

The burden of inflammatory bowel diseases (IBD), of which Chroh's disease and ulcerative colitis are the primary entities, is significant and wide ranging. IBD that is not well-controlled impairs quality of life, social activities, travel and ability to work, leading to higher rates of absenteeism and permanent work disability.1,2 The idiopathic intestinal inflammation of IBD requires life-long treatment and accounts for enormous hospitalization costs. According to data from the U.S. National Impatient Sample from 2004-2013, IBD was responsible for 97,865 hospitalizations in 2013 alone, with an annual hospitalization cost of $3.8 trillion.3 The 2015 National Health Interview Survey estimates that IBD affects 3.1 million Americans.4

Over the past two decads, the introduction of biologic therapies that target underlaying disease processes has dramatically changed the treatment of IBD. Current biologic therapy with tumor necrosis factor-α (TNF) inhibitors (i.e., infliximab, adalimumab, golimumab, and certolizumab pegol) and anti-integrins (i.e., matalizumab and vedolizumab) has improved the treatment of IBD flares and maintenance of clinical remission. These agends are, however, limited by lack of response and loss of response in a substantial proportion of patients, relapse and cessation of therapy, and effects such as risk for malignancy and infection.5 As the pathogenesis and treatment of IBD are complex and variable, there is a need to better understand the underlying pathogenic mechanisms and develop drug therapies to target these mechanisms.5

Orally administered, conventional drugs may improve adherence compared with parenteral administration. New drugs may prove to have better efficacy, tolerability, and cost-effectiveness, without a risk of immunogenicity. The oral Janus kinase (JAK) inhibitor, tofacitinib, was approved for use in ulcerative colitis in May 2018. Gastroenterologists can benefit from education that provides an update on the immunopathogenesis of IBD, a treat-to-target strategy of treatment, and data related to newer targeted synthetic agents.