The number of people with chronic inflammatory bowel disease (IBD) is estimated to double between now and 2030. People in the prime of social and working life, who have to live with a disease they are ashamed to talk about and which has an impact on social life very important. One of the so-called Mici is ulcerative colitis, a pathology that affects the colon with inflammatory lesions and which is linked to an inappropriate immune response towards components of the intestinal bacterial flora. In Italy it is estimated that around 150,000 people are affected, a number destined to increase in the coming years, also due to the spread of a diet rich in saturated fats and sugars.
Of these patients, about 30% do not respond to therapies, even the most recent ones, already after 14 weeks of treatment, and up to 75% of those who respond to treatment at the beginning do not maintain the response after 1 year. “Despite the various available therapies that have been introduced in recent years, there is a good proportion of patients who do not respond to treatment”, explains Flavio Caprioli, Secretary General of IG-IBD (Italian Group for the study of Inflammatory Bowel Disease) and Associate Professor of Gastroenterology, University of Milan. “So there are, again, both a therapeutic gap; and of the unmet needs related to symptomatology control”.
Inflammatory bowel disease, watch out for psychological symptoms
A new option
A new drug is now available for these patients: filgotinib. It is a molecule that inhibits the action of Jak-1, a protein that acts as a “guardian” of inflammation and keeps it active at the level of organs and systems. “Blocking JAKs therefore allows you to interrupt inflammation by acting at multiple levels. Compared to biological drugs, which block a single cytokine or a single protein expressed by immune cells, JAK inhibitors therefore have a more broad-spectrum action”, explains Gionata Fiorino, Clinical researcher and gastroenterologist, Vita-Salute San Raffaele University of Milan, Gastroenterology Unit, San Camillo-Forlanini Hospital in Rome. “One of the greatest benefits is given by the chemical structure of these drugs, which can be taken orally, because they do not have a protein structure like the others and are not degraded in the stomach”.
The Italian Medicines Agency has granted reimbursement of filgotinib for the treatment of adult patients with moderately to severely active ulcerative colitis who have not responded to or are intolerant to conventional therapy or a biological drug. Filgotinib is taken at home and not in the hospital.
A new drug is coming to turn off inflammation in Crohn’s disease
by Dario Rubino
Quality of life and adherence
Ulcerative colitis is a fluctuating disease, alternating more or less long periods of remission with exacerbations. A trend that undermines the quality of life of patients, who experience a feeling of uncertainty about possible relapses, but which also favors non-adherence to therapies: in fact, during periods in which the disease does not give symptoms, it often happens that people they forget to take the therapy. “In this context, the doctor-patient dialogue is fundamental. A survey conducted by our association on a sample of about 450 patients showed that 11% stopped treatment and did not tell their doctor; if we add to this that 13% stopped it, communicating it to the doctor, we have 1 patient out of 4 who is not adherent to the therapy. If the patient does not tell the doctor and the doctor does not notice it, we witness the failure of the therapeutic alliance, but above all there is an impact on the available resources due to a communication problem between doctor and patient, rather than a lack of efficacy of the therapies”, concludes Salvo Leone, expert patient, Director General of AMICI, National Association for Chronic Inflammatory Bowel Diseases. Exactly what should be avoided even in the face of new therapeutic options which, thanks to the speed of action and formulation, in the face of correct adherence, allow patients to have a better quality of life.
Psoriatic arthritis: first oral therapy of the JAK-inhibitor class available in Italy
