Canadian IBD Today

S1PR Modulators in the Management of Ulcerative Colitis: Considerations for Practice

Aaron Hass, MD, Laetitia Amar, MD, Robert Battat, MD, FRCPC — Mon, 09 Dec 2024 00:00:00 +0000

Sphingosine-1-phosphate receptor (S1PR) modulators are novel oral small-molecule therapies that offer a unique profile compared to other advanced therapies in the treatment of ulcerative colitis (UC), including oral administration, linear pharmacokinetic profiles, reduced immunogenicity, and lower costs associated with manufacturing.

The activation of S1P G-protein coupled receptors plays an inflammatory role in UC by promoting lymphocyte egress from lymphoid organs into circulation and colonic mucosa. S1PR modulators lead to internalization and degradation of these receptors, thereby reducing inflammation. Ozanimod was the first S1PR modulator approved for treating moderately-to-severely active UC and is also approved for multiple sclerosis. More recently, a second agent, etrasimod, was approved for UC. Etrasimod acts on different S1PR subtypes to avoid off target vascular and cardiac effects, has no up-titration regimen during initiation, a shorter half-life and less propensity for drug interactions. This review summarizes clinical trial and real-world data and provides guidance on the clinical uses of S1PR modulators.

Recent Advances in Complementary and Alternative Therapies for Inflammatory Bowel Disease

Jason Chambers, MD, Adam V. Weizman, MD, MSc, FRCPC — Mon, 09 Dec 2024 00:00:00 +0000

Inflammatory bowel disease (IBD) is a chronic relapsing-remitting inflammatory condition of the gastrointestinal (GI) tract, primarily comprised of 2 major types: Crohn's disease (CD) and ulcerative colitis (UC). The pathogenesis of IBD is not fully elucidated but is thought to be multifactorial involving genetic, environmental, and immunological contributors. The incidence of IBD has been rising worldwide, particularly in developed nations. Canada, in particular, has one of the highest prevalence rates of IBD globally, with recent data indicating that over 320,000 Canadians are living with IBD, making it a significant public health concern.

The chronic nature of IBD, along with the severity of its symptoms, and the adverse effects occasionally attributed to management (e.g. immunosuppression, corticosteroids, surgical complications) can significantly reduce the quality of life for those affected. As such, many patients with IBD use complementary and alternative medicine (CAM) due to safety concerns of conventional therapy and a sense of greater control over their disease. CAM refers to a broad range of healthcare practices, such as herbal medicine, acupuncture, homeopathy, fecal microbiota transplants, and probiotics, which are not typically considered part of conventional western medicine. The use of CAM among patients with IBD is high, with current or past use of CAM ranging from 21-60% of IBD patients. Given the propensity of patients with IBD to seek CAM and the unfamiliarity that many medical practitioners have with the evidence of benefit/harm from these practices, this review seeks to summarize recent advances in clinical research on CAM use for IBD.

Management of Anemia in Inflammatory Bowel Disease

Chris Sheasgreen, MD, FRCPC — Mon, 09 Dec 2024 00:00:00 +0000

Anemia is one of the most common complications of inflammatory bowel disease (IBD), with estimates of its prevalence varying from 9-74%. It is estimated to affect more than 1.2 billion people worldwide and evidence suggests that the incidence of anemia in people with IBD is almost double that of people without IBD (92.75 people with IBD per 1000 person-years vs 51.18 without IBD per 1000 person-years). Having a thorough approach to anemia in IBD is important because it is common and potentially dangerous, and because of its potential to arise from multiple different pathological and/or physiological processes.

Can Non-invasive Monitoring Replace Ileocolonoscopy for Postoperative Recurrence of Crohn’s Disease?

Shreya B. Kishore, MD, Sally Lawrence, MBChB, FRCPCH, FRCPC — Mon, 09 Dec 2024 00:00:00 +0000

The therapeutic landscape for Crohn’s disease (CD) has been reshaped by improvements in disease management and medical therapy, leading to a decrease in the necessity for intestinal resection. However, surgical intervention still plays a crucial role in treating medically refractory disease or complications such as strictures or fistulae. Recent biologic-era population studies have shown that the rate of CD-related abdominal surgery over 10 years is up to 49.9% in adult-onset CD and 37.7% in pediatric onset CD.

A Review of Pediatric to Adult Transition of Care in Inflammatory Bowel Disease

Natasha Bollegala, Hon BSc, MD, MSc, FRCPC — Mon, 09 Dec 2024 00:00:00 +0000

Canada is reported to have one of the highest rates of both incidence and prevalence of inflammatory bowel disease (IBD). Benchimol et al. conducted a population-based cohort study from 1999-2008 using health administrative data from Ontario, Canada, and reported that the prevalence of IBD in Canada in 2008 was 534.3 per 100,000 people (68,017 affected individuals among 12,738,350 Ontario residents). Between 1999 and 2008, the incidence of IBD increased annually in children under the age of 10 (9.7% per year, p<0.0001) and in those aged 10-19 (3.8% per year, p<0.0001).

Coward et al. published a similar population based health administrative data study using data from eight provinces in Canada. In this study the national incidence of IBD was estimated to be 29.9 per 100,000 (95% PI 28.3-31.5) in 2023.ll The incidence of IBD in pediatric patients was found to be increasing (average annual percentage change (AAPC) 1.27%; 95% CI 0.82-1.67). The prevalence of IBD was 843 per 100,000 (95% PI 716-735) in 2023 with forecasted increases (AAPC 2.43%;95% CI 2.32-2.54). In pediatric patients the prevalence in 2023 was 82 (95% PI 77-88) and the forecasted AAPC was 1.91 (1.46-2.31).

According to the 2023 Impact of IBD in Canada Report by Crohn’s and Colitis Canada, an estimated 322,600 Canadians are living with IBD, with 11,000 new diagnoses expected in 2023.

The global incidence and prevalence of IBD has been rising. In 2011, Benchimol et al. published a systematic review detailing international trends in IBD.The review demonstrated a 60% increase in Crohn’s disease (CD) and a 20% increase in ulcerative colitis (UC) across both developing and developed countries. Benchimol et al. also published the results of a health administrative data analysis evaluating children with a diagnosis of IBD between 1999-2010 across five Canadian provinces, which together account for 79.2% of the Canadian population. They reported that incidence of IBD in children aged five and under increased during the study period (annual percentage increase [APC] +7.19%; 95% CI, +2.82% to +11.56%). The prevalence of IBD also increased significantly during the study period (APC+4.56%; 95% CI, +3.71%
to +5.42%).