Proactive vs. Reactive Care in Inflammatory Bowel Disease Patients

In recent years, the number of individuals affected with a form of IBD such as Crohn’s disease or ulcerative colitis has begun to increase. As the number of patients presenting with the disease increased, physicians and medical researchers are beginning to develop more in-depth research on the disease in order to generate more effective treatment options. While some pharmaceutical companies have developed drugs that can be used to manage symptoms more conservatively than surgical options, doctors are still figuring out the best ways to administer these drugs. A recent study from the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center (BIDMC) and the University of Pennsylvania is exploring administration techniques to make the use of medicine maximally effective.

Treatment with medication

As the rates of patients suffering from IBD have risen in recent years, some pharmaceutical companies have responded by developing medications designed to help manage the symptoms of the disease. Among these medications are adalimumab and infliximab, which have become drugs commonly prescribed to patients suffering from Crohn’s or ulcerative colitis. The goal of these medications is essentially to help patients manage their symptoms so that they can continue with their day to day activities and avoid more intense and risky options such as surgery. While the medications have been generally effective, they’re not perfect.

The medications help manage symptoms by targeting the inflammatory protein tumor necrosis factor (TNF-alpha) which in turn will keep symptoms such as abdominal discomfort and pain at bay. The downside of these medications is that just because they erase some of the discomforts that can be caused by these diseases, they don’t cure the condition. Physicians have noted that while patients may not present with some of the symptoms commonly associated with Crohn’s and colitis, they can still be experiencing intestinal inflammation. Because the intestines may remain inflamed and can actually increase in severity, patients may experience relapses and may still have to opt for more drastic recovery measures such as surgery.

In fact, the possibility of relapse is one of the primary reasons that the usage of these drugs is being studied in more depth at the moment. Since a patient’s symptoms may be under control with the help of one of these medications, they may not realize that their Crohn’s or colitis is flaring up or potentially worsening. Once they do realize, it may be too late for conservative treatment. In these cases, doctors either have to administer an intense round of medication and therapy or patients may move into considering surgery as a more permanent fix.

In addition to erasing symptoms and sometimes causing relapse or a worsening of the overall condition, these medications can also have some pretty uncomfortable side effects. There haven’t been any instances of patient death recorded due to the use of any of these medications, but plenty of patients have had to stop using the drugs because side effects got too bad. Some common side effects included nausea, inflammation of the nose and throat, and headaches. Since these medications don’t always improve a patient’s Crohn’s or colitis, when combined with some of the severe side effects listed above, drugs aren’t always a good treatment option.

Proactive care vs. reactive care

Thankfully, the medical community isn’t satisfied with the status quo for IBD treatment. While the drugs that have been developed to manage the symptoms of Crohn’s and colitis aren’t perfect, they are a step in the right direction and they are helpful. Generally speaking, physicians believe that conservative treatment of these diseases is preferable to more drastic options such as surgery. While surgery can be helpful, if a medical provider can administer a treatment regimen that provides a patient lasting relief, then they’ll stick with this before opting for surgery. With that preference in mind, a recent study conducted by a team from the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center (BIDMC) and the University of Pennsylvania reports the results of an experiment designed to track the efficacy of using these drugs in a new way.

The study conducted by the team at BIDMC and the University of Pennsylvania focused specifically on infliximab. Before beginning the study, the research team noted that about 1.5 million Americans currently suffer from IBD, and that out of this 1.5 million about half of those who use a drug like infliximab to manage their symptoms will eventually develop an intolerance to the drug and be forced to seek an alternative treatment option. Developing an immunity or intolerance to the drug is one factor that can eventually lead to an intensification of the disease, especially when patients don’t realize that their bodies have stopped responding to the treatment.

In order to try and maintain the efficacy of the drug, the team from BIDMC and the University of Pennsylvania tested what they call proactive treatment with infliximab. Typically, medical providers practice reactive treatment with drugs. Reactive treatment is when a medication is prescribed and its efficacy isn’t tested or measured until a patient begins presenting with new symptoms or a resurgence of old symptoms. As discussed, this can be a big problem for patients of Crohn’s and colitis because their outward symptoms might be dormant while their intestines can be severely inflamed. With reactive treatment, doctors often discover that a drug has stopped working too late and have to resort to a more drastic treatment measure in order to provide the patient healing.

In contrast to reactive treatment, with proactive treatment doctors intentionally monitor a patient’s status at regular intervals to ensure that a treatment regimen is still effective. In this study, the research team measured the long-term effects of IBD medications on 264 patients, about half of whom were monitored proactively and half reactively. Out of the half who received proactive treatment, only about 13 percent had treatment failure. Alternatively, in the group of patients being treated reactively, 66 percent experienced treatment failure. Similarly, the probability that a patient would need to be hospitalized and the length of hospitalization was drastically lower with the group of proactively monitored patients as compared to the group monitored reactively, about 7 percent from the proactive group and 25 percent from the reactive group.

The results of this study demonstrate several principles that the researchers stressed for the medical community. Obviously, proactive treatment is preferable to reactive treatment. The patients who were monitored proactively experienced greater success with their treatment including a smaller chance of treatment failure and less likelihood of hospitalization. On top of that, patients who are monitored proactively were also more likely to see continued benefits from using these drugs to help manage their symptoms. This translates into serious long-term health benefits. The longer a patient can manage their symptoms conservatively, the less likely they’ll need to resort to riskier treatment options. While the research team indicated that their results should be followed up with additional studies, they also indicated that they’ve already adopted proactive treatment in their practices.

Final thoughts

The rate of IBD has steadily grown in the population over the last few decades. Thankfully, researchers have begun to develop medications that can be used to manage the symptoms associated with Crohn’s and colitis effectively without having to opt for surgery. While these drugs are certainly a step towards progress, they’re not yet perfect. As we continue to learn more about Crohn’s and colitis, hopefully, medical researchers will continue to study the effects of these drugs and the most effective treatment regimens for patients.

You can read more about this recent study from BIDMC and the University of Pennsylvania at Science Daily.