Endoscopy Given IBD Patients Within 6 Months of Starting Biologic May Limit Complications, Study Says

Endoscopy Given IBD Patients Within 6 Months of Starting Biologic May Limit Complications, Study Says
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An GI tract examination by endoscopy given within six months of starting treatment with a biologic may lessen the risk of complications in people with inflammatory bowel disease (IBD), a study found.

The study, “US Practice Patterns and Impact of Monitoring for Mucosal Inflammation After Biologic Initiation in Inflammatory Bowel Disease,” was published in Inflammatory Bowel Diseases.

Intestinal inflammation in Crohn’s disease (CD) and ulcerative colitis (UC) that’s not properly controlled can lead to complications, and a need for corticosteroid therapy, hospitalization or surgery.

This risk may be reduced by combining biologic therapies that help to keep GI inflammation under control with tools that allow physicians to monitor disease activity, including an endoscopy.

Although IBD patients are rarely given an endoscopy to monitor GI inflammation shortly after starting a biological therapy, data from the study led by Berkeley Limketkai, MD, PhD, the director of clinical research at the UCLA Center for Inflammatory Bowel Diseases, highlighted the importance of performing this procedure early on.

“Early endoscopic evaluation after the initiation of biologic therapy reduces the risk of disease-related complications and is consistent with the treat-to-target approach to IBD control,” Limketkai said in a news story written by Ted Bosworth.

“For every 1% increase in early proactive monitoring, there was a 0.6% reduction in the rate of disease-related complications at the end of two years,” he said.

In the study, Limketkai and colleagues analyzed health claims data from 19,899 patients with Crohn’s and 7,247 with ulcerative colitis who had started treatment with a biologic agent.

Patients were divided into two groups, depending on whether they had an early and proactive endoscopy. (The study defined an early proactive endoscopy as a procedure given within  six months of a patient starting treatment with a biologic agent, without criteria that would make the procedure mandatory — like starting treatment with corticosteroids, being hospitalized, or having bowel surgery.)

Biologic agents for IBD include Humira (adalimumab, by AbbVie), and Remicade (infliximab, by Janssen; generics are available).

The two-year incidence of disease-related complications — including use of corticosteroids, change of biologic agents, hospitalization and bowel surgery — was compared between the two groups.

Findings revealed that even though more than half of Crohn’s (56.4%) and UC patients (67.8%) underwent an endoscopy within the first two years of starting biologic treatment, only 11% of those with CD and 12.8% of those with UC had an early proactive endoscopy.

After two years of treatment, an early proactive endoscopy was associated with a 13% reduction in complications among UC patients, and 10% among those with Crohn’s, data showed.

Corticosteroid use had the biggest complication-related drop among those with an early proactive endoscopy (17% CD patients, 23% a UC), compared to those who did not have the procedure.

In ulcerative colitis patients, data showed that an endoscopy given four to six months after starting a biologic therapy had the best chances of lowering the risks of disease complications. No specific time interval was seen as superior to others among Crohn’s patients, but in general the earlier the procedure was performed, the better.

Although this retrospective study cannot state with certainty that early endoscopy will improve clinical outcomes for IBD patients, it does suggest the procedure helps in making necessary treatment adjustments before more severe symptoms are evident.

“These findings suggest that the benefit of early endoscopy may relate to proactive disease monitoring and early treatment optimization,” Limketkai said.

Study results were also presented at the 2018 Annual Meeting of the American College of Gastroenterology (ACG).

Joana holds a BSc in Biology, a MSc in Evolutionary and Developmental Biology and a PhD in Biomedical Sciences from Universidade de Lisboa, Portugal. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that made up the lining of blood vessels — found in the umbilical cord of newborns.
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Margarida graduated with a BS in Health Sciences from the University of Lisbon and a MSc in Biotechnology from Instituto Superior Técnico (IST-UL). She worked as a molecular biologist research associate at a Cambridge UK-based biotech company that discovers and develops therapeutic, fully human monoclonal antibodies.
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Joana holds a BSc in Biology, a MSc in Evolutionary and Developmental Biology and a PhD in Biomedical Sciences from Universidade de Lisboa, Portugal. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that made up the lining of blood vessels — found in the umbilical cord of newborns.
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