Sunanda Kane, MD: The Role of Small Molecule Therapies in IBD


Small molecule therapies offer patients with mild or moderate inflammatory bowel disease a much cheaper alternative to biologics.

As drug development continues to expand in gastroenterology, is there still a role for some of the older drugs?

That answer is yes according to Sunanda V. Kane, MD, Department of Gastroenterology and Hepatology, Mayo Clinic.

During the 2023 Digestive Disease Week (DDW) in Chicago, Kane spoke about the role of thioprines and methotrexate among a burgeoning list of biologics available to treat inflammatory bowel disease (IBD).

Kane said the small molecule class of drugs can be used in combination with some of the biologics commonly prescribed to treat Crohn’s disease and ulcerative colitis.

But the main advantage is that they offer patients, particularly patients with mild disease, a cheaper alternative, even to biosimilars.

“At most, the cost savings [of biosimilars] is 10-20% tops because you still have the need to manufacture them in certain types of plants,” Kane said in an interview with HCPLive®. “Something that is 20% cheaper than really expensive is still going to be expensive. Where thiopurines and methotrexate are not necessarily pennies on the day, but not more than a dollar a day.”

Kane also said it became clear that they underutilize these therapies.

“We have such effective biologics now that we tend to just forget about things that we’ve been using for years,” Kane said.

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