Among the hottest topics in the field of autoimmune disease is that of positioning therapeutic agents to achieve treatment goals. At the virtual Interdisciplinary Autoimmune Summit (IAS) 2020, two presentations focused on managing inflammatory bowel disease (IBD), including one specifically addressing this issue.
IAS 2020 senior advisor and presenter of these two sessions, Stephen B. Hanauer, MD—who is professor of medicine at Northwestern University Feinberg School of Medicine and medical director of the Digestive Health Center at Northwestern Medicine in Chicago, Illinois—answered some key questions on the importance of properly positioning new therapeutic agents.
AUTOIMMUNE LEARNING NETWORK: What new and emerging therapeutic agents have become available for the treatment of IBD?
Stephen Hanauer: Over the past several years a number of new agents for treating moderate to severe IBD have become available, and we have expanding comparative effectiveness studies, real-world data, and network meta-analyses that have extended our therapeutic database. These include leukocyte trafficking agents such as vedolizumab, anticytokines such as ustekinumab, and the first Janus-kinase (JAK) inhibitor for ulcerative colitis. Clinical trials are now underway examining evolutionary compounds for all these areas, including JAK inhibitors with different specificities, IL-23 agents, β-7 anti-integrins, and Sphingosine-1 phosphate agonists that are currently completing phase 3 trials.
ALN: What are the goals of optimal positioning of these agents?
SH: The goals of optimal positioning would be to maximize efficacy and minimize risks as we do with all therapies. However, we need to expand comparative effectiveness studies to incorporate multiple mechanisms at different stages of disease.
ALN: Should gastroenterologists position therapeutic agents differently depending on the type of autoimmune illness?
SH: Yes, we need to follow the evidence. For example, tofacitinib is effective for ulcerative colitis but the phase 2 trial in Crohn disease did not show efficacy. Other JAK inhibitors are demonstrating early results in Crohn disease, which makes consideration of JAK specificities more relevant.
ALN: What additional research is needed to more fully explore the optimum methods of positioning therapeutics for the treatment of IBD and other autoimmune illnesses?
SH: We need to continue to expand comparative effectiveness trials and real-world data. We need to change the culture for enrolling patients into clinical trials so that we have more evidence to direct our therapeutic recommendations.