Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment

Abstract

The inflammatory bowel diseases (IBD) are chronic incurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mild-moderate colitis, and do not work in Crohn’s; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn’s; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically (not monitored) causing further increase of their cost over that of hospitalization. Against all these caveats, two simple rules still hold true: Strict adherence maintenance and avoidance of colitogenic drugs. This matter is expanded in this minireview.

Real‐world evidence on adherence, persistence, switching and dose escalation with biologics in adult inflammatory bowel disease in the United States: A systematic review

“…Non‐adherence and non‐persistence have been described as two independent constructs that have been extensively shown to result in increased morbidity, mortality and healthcare costs . The lack of adherence has been shown to affect disease remission in IBD . When maintained, disease remission is associated with lower healthcare costs, fewer hospitalizations and improved quality of life .…”

“…3 The lack of adherence has been shown to affect disease remission in IBD. 4 When maintained, disease remission is associated with lower healthcare costs, fewer hospitalizations and improved quality of life. 5 Thus, increasing adherence to IBD therapies may lead to better health outcomes.…”

p-Cymene and Rosmarinic Acid Ameliorate TNBS-Induced Intestinal Inflammation Upkeeping ZO-1 and MUC-2: Role of Antioxidant System and Immunomodulation

“…Moreover, drug therapy is constantly associated with several side effects that contribute to treatment non-adherence [18,21]. Additionally, they constantly fail to prevent IBD active phase relapse [2,22]. To promote new pharmacological approaches, researchers are considering natural products as promising in drug discovery.…”

Orally Deliverable Nanotherapeutics for the Synergistic Treatment of Colitis-Associated Colorectal Cancer

“…In addition, IBDs typically have characteristics of recurrence and persistence. A considerable number of patients suffer from unsatisfactory treatments and eventually develop CAC after more than 10 years 46, 47. Therapies, including irinotecan, oxaliplatin, 5-fluorouracil/leucovorin, and bevacizumab, have been used in single and combined administrations as anticancer drugs in the late stage of CAC 6, 7, 48.…”