IBD: A gripping issue
IN MAY, IRRITABLE BOWEL DISEASE WAS MARKED AROUND THE WORLD. SP TAKES A LOOK AT RECENT ADVANCES IN RESEARCH OF THIS DISTRESSING CONDITION…
E
very 30 minutes, someone in the UK is diagnosed with Crohn’s Disease or ulcerative colitis – the
two main forms of Inflammatory Bowel Disease (IBD). This means that at least 300,000 people in the UK are diagnosed with IBD each year.
Now, a new survey of IBD patients and physicians by Bristol-Myers Squibb has found that there are urgent and unmet needs in several key areas, including differences in expectations between patients and physicians that may impact disease management and treatment decisions.
What is ulcerative colitis? Ulcerative colitis (UC) is inflammation of the lower end of the digestive system, including the large bowel and rectum. Common symptoms of UC include frequent diarrhoea (which may be bloody), stomach aches and frequent urination. There may also be extreme fatigue, loss of appetite and weight loss.
The severity of the symptoms varies, depending on how much of the rectum and colon is inflamed and how severe the inflammation is. UC is usually treated with medicines that reduce the inflammation in the digestive system, but severe cases may require surgery.
It's not clear what causes ulcerative
colitis, but one cause that has been suggested is that the immune system is ‘attacking’ the digestive system.
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What is Crohn’s Disease? The most common symptoms of CD are cramping, diarrhoea and fever. At present, there is no cure for Crohn’s disease, and so treatment generally focuses on controlling the symptoms and improving the quality of life for people with this condition.
The most common treatment options include anti-inflammatory medications, corticosteroids, immunomodulators and antibiotics. While diet and nutrition management will not cure CD, it can help patients to maintain adequate nutrition and manage flare-ups. Doctors will describe an individual as being in remission once their inflammation is under control.
Survey findings disappointing for patients The IBD Global Assessment of Patient and Physician Unmet Needs Survey (IBD GAPPS) captured insights and perspectives from more than 2,000 IBD patients and 600 physicians, exploring the physician-patient relationship, how patients and physicians define remission, their treatment expectations and levels of satisfaction with current therapies, as well as the impact of UC and CD on disease-related quality of life.
Results from the survey were presented at the fifteenth Congress of the European Crohn's and Colitis Organisation (ECCO) in Vienna, Austria.
Among the findings: • There are important differences between how IBD patients and physicians define ‘remission’. The survey revealed important and meaningful differences in how patients and physicians define IBD remission. The majority of physicians defined remission based on clinical test results (64 per cent of physicians for CD, 70 per cent for UC) whereas patients (45 per cent) most commonly defined remission as the resolution of IBD symptoms. Additionally, while most physicians and patients acknowledge discussing remission (93 per cent of physicians, 78 per cent of patients), their distinct definitions of remission highlight a need for greater alignment.
• The high prevalence of corticosteroid use reflects significant unmet need for improved therapies. Results from IBD GAPPS showed that more than one third of IBD patients (35 per cent of CD patients, 39 per cent of UC patients) used corticosteroids for four or more months over the past year to control their disease. Physicians believe more than 40 per cent of IBD patients will require four or more months of corticosteroid use per year to maintain disease control. Yet, despite high patient concern over any corticosteroid use, and most patients wanting to stop corticosteroid treatment as soon as their disease is under control, only approximately
50 per cent of physicians expressed concern over four or more months of corticosteroid use per year.
• Physicians’ satisfaction with
remission rates and sustained treatment response may impact treatment outcomes. Based on the survey findings, physicians’ satisfaction with relatively low IBD remission and durability rates may suggest an acceptance of sub- optimal outcomes in chronic disease control. Physicians indicated up to 63 per cent of IBD patients will not obtain remission with current therapies; however, many physicians are highly satisfied with these results (25 per cent of physicians for CD, 36 per cent for UC).
Despite these low physician expectations, most patients believe remission is a feasible treatment goal, and approximately one-third of patients expect their treatment to provide five or more years of disease control. These expectations exist despite many patients (61 per cent) reporting only partial IBD control with current therapies.
The survey findings will cause distress for many IBD patients for whom, at present, there is no cure. While drugs and in some cases surgery can provide some relief from the symptoms of CD and UC, it is estimated that one in 210 people are living with these unpredictable, life-long and potentially life- threatening conditions.
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