Alan Moss, MD, on Strategies to Optimize Outcomes in Luminal Crohn Disease

Dr Moss, from Boston University, reviewed 3 key steps in optimizing care for patients with luminal Crohn disease during his presentation at the Advances in Regional Bowel Diseases regional meeting.

Alan Moss, MD, a professor of medicine and director of the Crohn’s & Colitis Program at Boston University Medical Center in Boston, Massachusetts.

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TRANSCRIPT:

Alan Moss, MD:

Hi, my name is Alan Moss. I'm a professor of medicine at Boston Edison School of Medicine. I'm here at the ARBD regionals meeting, and today I've been talking about strategies to manage luminal Crohn's disease. I'm going to share with you three key take homes from this talk. The first one is to identify the patients who need advanced therapies earlier in the disease course. The rationale for this is that we recognize that many patients get treated far later in the disease course than we would like, often when complications are already established or have occurred. It will be far better for us to treat these patients earlier in the disease course and try and prevent complications. And so with that in mind, I have pointed out or emphasized some of the key things to look at when you're looking at how to diagnose Crohn's disease, which patients are considered high risk for complications, and which patients may be considered low risk for complications so we can identify them early and select for advanced therapies much earlier in the course of the disease before complications have developed.

The second piece of the talk is focused on the different therapies that are approved by the FDA for Crohn's disease. Many of these are approved for both ulcerative colitis and Crohn's disease, but some are currently only approved for Crohn's disease. Some of the agents include anti-TNFs, anti-IL-23s, and also the JAK inhibitors, and specifically focus on both their efficacy and their safety in patients with Crohn's disease. In these data, we have particularly focused on who has benefits, who are [inaudible 00:01:41] anti-TNFs, and who actually benefits even after TNF exposure. Also focused on safety, and what are the main safety or adverse events to look for in your patients with Crohn's disease on these advanced therapies.

The third part of the talk is really focused on how to select an individual therapy for a given patient. It used to be we had only a small number of drugs to use in luminal Crohn's disease. Now we have many different mechanisms of action. We've got to decide for a given patient, what's the best drug for that person at a given point in time? And so when we look at this, we're often thinking about factors such as the patient's age, their comorbidities, other medications that they're taking, what their risk factors are for complicated disease, and then also, realistically what their payer may approve based on FDA approval and their individual plan.

As we think about different agents, we try to focus on agents that are associated with less risk of side effects in those who are at greatest risk of side effects. For example, we think about agents that have risk of infections, risk of lymphoma or cancers, and risk of cardiovascular events. That's very important to consider. And then also the patient's preference. Do they like pills? Do they like subcu injections, IV infusions? What their preference is there in terms of mode administration and also convenience.

And so the talk has really hopefully helped guide you for a given patient measuring all those different factors, their medical factors, the payer factors, the convenience factors, and then from that, select one particular agent that will work best for your patient, and also considering their prior drug exposures. And so with those three things in mind, early identification of patients with luminal Crohn's disease, comparing the efficacy and safety of different agents, and then selecting an individual agent for a given patient, hopefully you'll find this helpful when you're picking agents for your patients and practice. Thank you.

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