Raymond Cross, MD, on Putting it All Together: Selecting Therapies for IBD
Dr Cross discusses the key points from his address at the AIBD regional meeting in Chicago on how to choose the best therapies for patients with IBD by assessing disease severity, disease activity, extraintestinal manifestations and more.
Raymond Cross, MD, is director of the IBD Center at Mercy Medical Center in Baltimore, Maryland, and professor of medicine at the University of Maryland. He also hosts the AIBD Network's "IBD Drive Time" podcast.
Transcript:
Hi everyone. I'm Raymond Cross from Mercy Medical Center and I'm at the Chicago Regional AIBD, where I just did a presentation called Putting It All Together, patient and disease related factors to help you select treatments in IBD.
I think if I had to take one key point from that presentation, it's really getting patients on an advanced therapy sooner. Surprisingly, only about 15% of people in the United States are treated with an advanced therapy for Crohn's, and it's less than 10% for ulcerative colitis. So my presentation focused on assessing disease severity so that you can identify patients with a moderate to severe disease course in Crohn's and ulcerative colitis. And also assessing activity, both symptoms and inflammation, that is going to categorize a patient’s having moderate to severe disease. Our current guidelines recommend advanced therapy in all of those patients without needing to step up through 5-ASAs and corticosteroids to get to those advanced therapies.
We talked about the evidence base for early treatment and different trials that have shown that outcomes, both clinical and other outcomes such as hospitalizations and need for surgery, are in fact reduced if you start advanced therapy early. And also adverse events, which we typically attribute to advanced therapies, are actually less in patients who get early treatment, likely because their disease is well controlled.
Once you've identified a patient for advanced treatment, we then talked about looking at different patient and disease characteristics. It'll help you select the right therapy for the right patient, and that can include patient factors such as a desire for oral versus injectable therapy. It can be insurance restrictions in your region, rapidity of onset for patients who have more severe disease, concurrent immune mediated conditions or extraintestinal manifestations that are going to help you select the therapy, prior advanced therapy exposure, and which therapies you would use in that setting.
And then we talked about some different tips from a staff perspective, a patient perspective, and a provider perspective, to increase the chance that you can get these medications approved. That includes simple things like prioritizing prior auths that need to be done more quickly, including a repository of studies that are going to help support appeals when a drug is rejected, signing patients up for copay assistance, using pharmaceutical access programs and other things and samples to get your patients on drugs, teaching your patients to be an advocate for themselves and following up when the drug is not getting approved in a timely fashion. And then as providers, trying to again, help provide resources for your staff for appeals, making sure that you do the appropriate diagnostics so there's no diagnostic delays and always being empathetic for your patients and understanding the ordeal they're going through to get on drugs.
So thank you very much for your time and hopefully you'll be able to review my lecture.
