Advancements Alter the Landscape for IBD Treatment

The opening day of the Asembia that achievement of mucosal healing with Specialty Pharmacy Summit 2018 was dedicated to continuing education sessions highlighting the role of pharmacists within the rapidly evolving specialty drug landscape. One of the key sessions, Preventing Crohn’s Disease and Ulcerative Colitis Progression With Biologic Therapies, outlined just how these breakthrough drugs are changing the way in which health care providers need to manage patients with chronic diseases.

The symposium kicked off with an inspiring message from Rolf Benirschke, a legendary player in the National Football League (NFL) and a tireless advocate for patients with inflammatory bowel disease (IBD). In 1979, during his third season as a placekicker for the San Diego Chargers, Benirschke developed life-threatening complications from IBD that required emergency surgery and a prolonged stay in the intensive care unit. After recovering from the ordeal, he returned to play in the NFL for 7 more seasons. He was the first NFL player to wear an ostomy bag. Benirschke has received accolades for his work with the Crohn’s & Colitis Foundation. In the next part of the program, Christopher Owens, PharmD, MPH, gave an overview of IBD management. He reviewed the pathophysiology, epidemiology, and clinical features of IBD.

Owens delved into the challenges that patients with IBD face, including hospitalizations, high medical costs, and symptoms that impair quality of life. He outlined treatment options for induction and maintenance of remission. Pharmacologic options include nonbiologic drugs (eg, corticosteroids, aminosalicylates, and thiopurines), tumor necrosis factor (TNF) inhibitors, and other biologic drugs. Owens explored current issues in management, such as pharmacogenetic markers, to guide therapy and therapeutic drug monitoring. He explained the recent paradigm shift away from a “bottom-up” step-care treatment approach with symptom relief as the target to a “top-down” treatment approach with mucosal healing as the target. Multiple lines of evidence indicate that achievement of mucosal healing with earlier and more aggressive treatment leads to better outcomes, including prolonged remission and fewer IBD complications.

Owens concluded this portion of the symposium by reviewing new clinical pathways and algorithms for ulcerative colitis and Crohn disease that stratify treatment according to disease severity. In the final presentation of the symposium, Kelly Mathews, PharmD, CSP, explored the nitty-gritty of specialty pharmacy care for patients with IBD. She began by reviewing the efficacy and safety of TNF inhibitors and other biologic drugs for ulcerative colitis and Crohn disease. Biologic drugs for IBD are expensive, immunosuppressive, and usually self-administered by subcutaneous injection. After addressing the current status of biosimilars, Mathews outlined the myriad responsibilities of specialty pharmacists who care for patients with IBD.

Key pharmacist responsibilities include helping patients obtain insurance benefits and financial assistance, screening for infectious diseases that can be affected by immunosuppression, monitoring for infections and educating patients about them, ensuring appropriate vaccinations before and during treatment, teaching patients to store biologics correctly and self-administer injections, and using motivational interviewing and other patient education techniques to help patients achieve better outcomes. Mathews ended her presentation with a discussion of questionnaires and scoring systems that measure the treatment response to biologic drugs in IBD. As value-based health care gains traction, specialty pharmacists are taking on a new role: measuring and reporting outcomes in patients with IBD.