Miguel Regueiro, MD, on Treating IBD: Time is of the Essence
Inadequate treatment of inflammatory bowel disease (IBD) can be considered an adverse event, according to Miguel Regueiro, MD. This, he says, is due to the serious consequences of inadequate treatment including flares, cardiovascular disease, and colorectal cancer.
Regueiro, who is the chair of the Department of Gastroenterology and Hepatology and vice chair of the Digestive Disease and Surgery Institute at Cleveland Clinic in Ohio, spoke about the importance of treating IBD effectively and efficiently, as well as the positioning of therapeutic drug monitoring, during one of his sessions at AIBD Regionals in Boston.
Regueiro offered attendees 2 key takehome messages regarding the treatment of ulcerative colitis (UC): act faster and recognize the importance of colectomy.
“The days are gone that we sit on a UC patient on steroids, in my opinion, more than 2 days. We used to say 7 days, but we realized many of these patients come in already on oral steroids and failing oral steroids, and so we need to act much faster,” said Regueiro.
Regueiro said it is crucial to know when to perform a colectomy.
“If a patient fails 2 10 mg/kg doses of infliximab within 5 days of being hospitalized, they go to a colectomy,” he continued. “I do not mess around with anything else—I do not put them on cyclosporine or tofacitinib; they go to surgery. In my opinion, that is a patient that has a bad outcome if we do not act soon.”
In addition to highlighting the need to treat in a timely manner, Regueiro also reviewed therapeutic drug monitoring (TDM).
“Certainly, I think reactive testing for those who are not proactively testing,” he said. “If you have a patient who is losing a response, especially to infliximab and adalimumab, I think checking levels then and seeing if they have antibodies makes sense, and I think most of us have been doing that for a while.”
Regueiro pointed out various knowledge gaps in TDM that still need to be bridged, including how to improve accuracy, accessibility, and cost, as well as the need for more prospective data.
Regueiro MD. Beyond combination therapy in IBD: what have we learned?. Presented at: Advances in Inflammatory Bowel Disease Regionals. June 15, 2019; Boston, MA.