Managing Care for IBD Patients Not Responding to Treatment


Experts discuss how to care for Inflammatory Bowel Disease (IBD) patients who are not responding to treatment.


David Hudesman, MD: Anita, let’s follow that train of thought. [Let’s say] a patient is doing well on 1 therapy and then starts to have worsening symptoms. If they’re worsening symptoms, how do you approach that patient?

Anita Afzali, MD: First, we need to emphasize the importance of symptoms and objective data to determine whether there’s active ongoing inflammation. This is very important because we know, especially for Crohn disease, it doesn’t necessarily correlate. First, whatever medication we initiate, we want it to be effective for our patients, and that’s what they want. Once they start it, what’s important is proactive disease monitoring—not drug-level therapy—to make sure that whatever you’ve initiated is effective for them in terms of symptoms and based on objective data. My approach is if the patient is able to be monitored, get some biomarkers, fecal calprotectin, and CRP, and determine if their symptoms are also associated with the objective information. If they’re not responding to therapy, perhaps we have to optimize their treatment regimen. Before I make any immediate changes, as a rule of thumb, we need to evaluate symptoms clinically but also look for objective evaluations.

David Hudesman, MD: This was a nice way to start, a nice overview on how we approach our patients. Obviously, our therapies need to work. Safety is tied to efficacy and shared decision-making.

Transcript edited for clarity.

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