In a recent meta-analysis of almost 300 trials, researchers found a correlation between dual biologic or small molecule therapy and a reduced need of surgery in refractory IBD. Refractory IBD is simply Crohn’s or Colitis that is defined as persistent and acute and has not responded well to anti-inflammatory therapies. At Weill Cornell Medicine in New York, researchers found that after analyzing the trials that 58% of refractory IBD patients achieved clinical and endoscopic remission with dual biologics. They also found that 34% achieved remission with dual small molecule therapy. Overall, the majority of these patients were able to avoid surgery, with only 12% requiring it.
The most common dual therapies include tumor necrosis factor-a and anti-integrins. A little over 60% of patients on those dual therapy had previously not responded to one of the two therapies on its own. This gives hope to those who have IBD and have not responded previously, giving another option before surgery. Of the almost 300 patients, 76% had refractory Crohn’s disease, suggesting it is harder to treat and keep in remission as it can affect the entire digestive system, and commonly has more complications than Ulcerative Colitis.
Researchers conducted a follow up with patients after 32 weeks on dual therapy to assess the safety profiles. Only 6% had adverse effects, deeming this safety profile of the dual therapy approach safe. It is worth noting that those who have rheumatoid arthritis in particular, do have a higher risk of adverse effects on dual biologic care. While this dual therapy approach has encouraging data to back it, more research needs to be done. Perspective clinical trials using this approach are underway as you read this, leading researchers to believe they will have more concrete evidence after these trials conclude.
Scientists and researchers are eager to get the results from the multiple IBD trials using dual therapy. There are many possible positive outcomes for early treatment using this approach, but many unanswered questions. The biggest in Robert Battat’s (MD Weill Cornell Medicine in New York City) eyes is “If this strategy was initiated early in the diagnosis, could it affect the natural course of the disease in a positive way and prevent hospitalizations and need for surgery?” This could lead to a better quality of life for those who have refractory IBD, and may be implemented as another step before looking to surgery.
Want to check out the meta-analysis for yourself? Click HERE!
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