Dr Regueiro reviews his presentation on positioning therapies for IBD from the session on pathophysiology at the American College of Gastroenterology postgraduate course on October 21 in Vancouver.

Miguel Regueiro, MD, is professor of medicine and chair of the Digestive Disease & Surgery Institute at Cleveland Clinic in Cleveland, Ohio. 

TRANSCRIPT:

I'm Dr. Miguel Regueiro. I'm Professor of Medicine and Chief of the Digestive Disease Institute at Cleveland Clinic in Cleveland, Ohio. And I'm coming to you from the American College of Gastroenterology 2023 in Vancouver, Canada. It's been a great meeting so far and I'd like to highlight one of my presentations that occurred on the first day of ACG. This was part of the ACG Pathophysiology Course where I presented the therapies for inflammatory bowel disease, both Crohn's disease and ulcerative colitis. I went through the different mechanisms of action. This is an exciting time for IBD therapies, a lot of hope for our patients. And then I also presented a new safety pyramid, which we've put together over the years, and we've just recently updated this and published this in the IBD Journal, and I spent some time talking about that.

Part of my presentation in the ACG Pathophysiology Course was how I position these therapies in my own clinical practice. A few highlights include, in very severe ulcerative colitis patients admitted to the hospital, if they've never been on a treatment, I still use Infliximab and I tend to use the 10 milligram per kilogram dose. If they've already been on Infliximab, there are now emerging data on Janus kinase inhibitors, tofacitinib, and now maybe even upadacitinib. I also talked about Crohn's disease. So, for the severe Crohn's patient with perianal fistula and also very severe Crohn's in the GI tract, I'm still using Infliximab in combination with azathioprine. For everything else, moderate Crohn's disease and moderate ulcerative colitis, I take a bit of a different approach and we have lots of therapies.

So, for moderate Crohn's disease, we have vedolizumab, ustekinumab, now risankizumab. We're actually looking at other therapies even beyond the anti-TNF. If a patient has been on a TNF inhibitor and failed that in Crohn's, I am starting to use more and more upadacitinib. Similarly, for ulcerative colitis, we have a whole new class of therapies, the SS1P molecules, ozanimod, and just approved etrasimod. I think those are best used in the milder end of moderate ulcerative colitis as first-line therapy after a 5-ASA. And then obviously we have ustekinumab, vedolizumab, the TNF inhibitors, and always upadacitinib for that group as well. So hopefully you all learned something from this and I hope to see you at ACG.