Therapeutic Optimization in Crohn's Disease - Episode 23
Stephen B. Hanauer, MD: The future of therapy for Crohn disease, in particular, is to identify the correct drug for the right patient. At the moment, we do not have biomarkers or predictors for any individuals with any of our drugs that we’ve discussed in our therapeutic armamentarium—hence, we have to invoke this shared decision making. As newer biomarkers and predictors of response to therapy become available, we’re going to profoundly improve patient targeting based on whichever biomarkers are available. At the moment, we need to use the risk and benefit across this menu of therapies that we’ve already discussed in a shared decision-making manner. The future will be to identify better targets or networks of inflammatory mediators along the lines that are being used in cancer therapies where most of those are either genetic or based on molecular profiling.
Presently, we’ve had limited-benefit individual therapies. As we look across at our oncologic colleagues, they are using multiple medications that look at several different pathways. I believe that combination therapy will be most useful. At the moment, we do not know the best combinations, but we’ve been using them forever: we’ve been using immunomodulators after corticosteroids; and we’ve identified the combination therapy with infliximab [Remicade] and a thiopurine is more effective than infliximab alone. So we need to identify which combination of either conventional therapies with a biologic or even combining biologic mechanisms of action, to optimize the individual patients. The problem at the moment is the cost—if we have to use 2 biologic therapies, the cost is going to be prohibitive.
Transcript edited for clarity.