Dr Barnes provides updates on advances in the treatment of ulcerative colitis, including the new therapies approved in the past year and how those therapies could change clinical practice.

Edward Barnes, MD, is an assistant professor of medicine and associate director of the Gastroenterology and Hepatology Fellowship Program at the University of North Carolina School of Medicine at Chapel Hill, North Carolina.

TRANSCRIPT:

Hi, I'm Ed Barnes from the University of North Carolina at Chapel Hill, and here at DDW, I had the pleasure to present in the post-grad course and talk about updates for the past year in ulcerative colitis.

This is a really interesting discussion for a couple of reasons, one of which is that we've had a lot of exciting updates in ulcerative colitis, and we did this in a format where it was really conversational, where we talked about these updates and how they can really change clinical practice at this time in 2024, but also where the field is going. So this was a really exciting sort of session, and I hope that it was helpful for people.

To sort of hit the highlights of what we talked about in this post-grad course: First, we talked about new therapies that have been approved in ulcerative colitis in the last year, and those include both mirikizumab and etrasimod. And went through with the data in terms of what led to those therapies being approved by the FDA. But more importantly, we talked about how those therapies sort of would change clinical practice, how patients might expect onset of action and some sort of novel things within the study designs that may be sort of applicable to your patients in terms of utilizing those therapies right away.

An example of that is the urgency numeric rating score that was used in the mirikizumab trial design and how we know that urgency is really important when we think about patients with ulcerative colitis but within the mirikizumab trial program they actually quantified in urgency and how urgency correlated with other sort of markers of how well patients responded to that therapy.

We then thought about sort of other scenarios within ulcerative colitis like acute severe ulcerative colitis, recognizing that as patients sort of move through that ulcerative colitis treatment regime, they may have been improved, may have already been treated with our other therapies for acute severe UC that we've traditionally relied on, like inflixumab in the outpatient setting. That sets the stage for us to think about new therapies that we might have to use in the hospital, things like JAK inhibitors that have received a lot of attention within the past year. And we talked about 2 different studies in particular, one of which was the TACOS trial, looking at tofacitinib versus placebo, where placebo was actually just IV steroid therapy, and then also looking at a retrospective study, looking at upadacitinib in the setting of acute severe UC.

That led to a lot of interesting discussion about where we think the treatment of acute severe UC is going in the future as we have these rapid onset therapies and thinking about some of our sickest patients with UC. We wrapped up by talking about some of the guidelines that have been published in the UC space within the past year from the AGA. Those include the biomarker guidelines and the guidelines for pouchitis. And for the pouchitis guidelines, what we really tried to focus on was practical definitions for inflammatory conditions of the pouch and how we can use those to sort of speak the same language from institution to institution, but also to inform our practice, leveraging data that's been published in the last year like the EARNEST study looking at vedolizumab versus placebo, but also to inform the treatment of patients with chronic arthritis with other advanced therapies that may also be beneficial.

So I think it was a really high-level discussion, it was really interactive, we had a lot of great questions from the audience and I hope that this summary was helpful and you can go back and look at that talk if this is of interest to you.

So thanks very much and I appreciate the opportunity to share these insights with you.