How to help patients get better control of their IBD

Just over 320,000 Canadians live with inflammatory bowel disease (IBD), the two main forms of which are Crohn's disease (CD) and ulcerative colitis (UC). A study conducted in 10 centres across the country suggests that for approximately half of these patients, the disease is not optimally controlled, leading to repercussions on their quality of life. “Despite the increasing availability of treatment options for patients with IBD, treatment goals are not always met, which may increase the risk of future complications and lead to unnecessary suffering for patients,” the Canadian researchers, led by University of Alberta gastroenterologist Dr. Jesse Siffledeen, observed in their article published in the journal Digestive Diseases and Sciences.“It is important to frequently monitor patients with IBD to ensure that therapeutic goals are achieved and that therapies are adjusted if necessary,” the authors wrote, adding that their results suggest that there is a need for better understand the facilitators and barriers to implementing STRIDE-II targeted treatment (IBD) strategies in Canadian practice.The STRIDE-II program guidelines (for “Selecting Therapeutic TaRgets in Inflammatory Bowel DiseasE II”) were published in 2021 by the International Organization for the Study of IBD. They guide clinicians so that they can help their patients achieve their short-, medium- and long-term treatment goals. These range from reduction or elimination of symptoms to clinical remission, freedom from disability and restoration of quality of life, including normalization of C-reactive protein, reduction of fecal calprotectin or restoration of the growth curve in children.The study in question aimed to evaluate the application of the recommendations of this program and, therefore, whether patients with IBD are able to achieve disease control. To do this, 163 patients (87 with CD and 76 with UC) were selected from coast to coast. None were hospitalized. Patients with CD (44.8% women) were aged 32.9 years at diagnosis while those with UC (55.3% women) were aged 34.2 years, with median durations illness of 10.0 and 10.5 years, respectively. Patients, along with their treating physician, had to meet a series of criteria—frequency of bowel movements, recurrence of abdominal pain, lack of clinically significant improvement, failure of clinical remission or endoscopic remission, excessive use of corticosteroids, etc.—which constituted warning signals of non-compliance with disease control indicators as defined by the STRIDE-II program.Ultimately, the proportions of patients with red flags indicating suboptimal disease control were 51.7% for Crohn's disease (45/87; 95% confidence interval [CI], 40. 8% to 62.6%) for CD and 43.4% for UC (33/7; [CI] 32.1% to 55.3%). The majority of these patients were identified based on long-term warning signs, including impaired quality of life.Tendency to overestimateThe results also show that both patients and clinicians tend to overestimate disease control. “Only 15.0% of CD patients and 18.6% of UC patients identified themselves as having suboptimal disease control. According to clinicians' statements, 19.5% of patients with CD and 25.0% of patients with UC had suboptimal disease control,” the article stated.“There is a gap between patients' and doctors' perceptions of disease control and what objective measures show. In reality, about half of people are not doing as well as they could,” said Dr. Siffledeen in a press release. “By informing doctors of these results and encouraging the application of the recommendations provided in the STRIDE-II program guidelines, we could transform the management of IBD.” This Canadian study is part of a larger study called IBD-PODCAST (“Proportion of Inadequate Disease Control and Strategy of Treatment in IBD”) and supported by the AbbVie laboratory. This involved 2,185 patients (1,108 with Crohn’s disease and 1,077 with ulcerative colitis) from 10 countries: Austria, Belgium, Canada, Germany, Greece, Italy, Portugal, Spain, Turkey and the United Kingdom. The Canadian results are consistent with those observed in all the countries concerned.

How to help patients get better control of their IBD

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