Michael V. Chiorean, MD: UC Treatment Landscape Will Boom

The therapeutic landscape for ulcerative colitis (UC) is expected to boom over the next several years, according to a presentation at the Advances in Inflammatory Bowel Disease Regional Meeting in Los Angeles. These developments may prompt changes in the current UC treatment paradigm and algorithm.

Michael Chiorean, MD, who is director of the IBD Center at Virginia Mason Medical Center in Seattle, Washington, discussed emerging therapies and their impact on the UC treatment landscape and research focus during his presentation at today’s meeting.

Chiorean called the current treatment landscape “barren.” With 3 anti-TNFs, 1 anti-integrin, and 1 JAK inhibitor, there are only 5 targeted therapies for UC. By 2025, Chiroean expects there to be more than 20 advanced therapies, including new classes of anti-interleukins and S1-PR modulators.

“The interlukin-23 pipeline is very rich, and JAK-STAT will see an explosion in the next years,” said Chiorean. “The future will be a dual between small molecules and biologics.”

Currently, small molecules appear to be dominating that dual, he explained, with JAK inhibitors and S1-PR modulators having better immunogenicity, convenience, interchangeability, and 5-year cost horizons.

In fact, Chiorean expects that small molecules will soon become first line agents for the treatment of moderate to severe UC. While JAK inhibitors will likely serve as first line agents for severe UC, anti-TNFs will become second line agents.

Steroids may also be less useful for patients.

“JAKs work so fast that you probably can get by without steroids especially because you will need a maintenance agent later anyway,” said Chiorean. 

Chiorean also predicts there will be staged therapy; a move toward combination therapy; and research more focused on personalization, synergism, and optimization.

“I also think we need to figure out targets—predictors of response for each class,” said Chiorean. “There will be 23 drugs in 6 years, and you cannot just go blindly about which one you will pick.”

—Colleen Murphy

Reference:

Chiorean M. Recent and emerging therapies for UC. Paper presented at: Advances in Inflammatory Bowel Disease Regionals. April 6, 2019; Los Angeles, CA.