Inflammatory bowel disease (IBD), is primarily composed of Crohn’s disease (CD) and ulcerative colitis (UC) and affects as many as 1.6 million Americans, with approximately 30,000 new cases diagnosed each year. Both are marked by an abnormal response by the body’s immune system, sharing some similar symptoms. However, there are important differences between the two diseases.
What is IBD?
The exact cause of IBD is unknown, but studies indicate that IBD is at least partly the result of a dysfunctional immune system. A properly functioning immune system attacks foreign organisms, such as bacteria and viruses, to protect the body. In individuals with IBD, the immune system responds incorrectly to environmental triggers, most often food, bacteria, or other materials in the gastrointestinal tract for foreign substances, which causes chronic inflammation of the digestive tract. This chronic inflammatory response results in damage to the digestive tract and can have serious consequences.
Crohn’s disease
Crohn’s disease (CD) can affect all areas of the digestive tract, from the mouth to the anus, and may penetrate through the intestinal wall to involve the connective tissue surrounding the gut. This can lead to some complications, such as narrowing of the intestine, abscess formation, or the formation of abnormal connections from the bowel to other structures.
In most cases, CD is found at the end of the small intestine (small bowel) and the beginning of the colon (large bowel). CD can also affect the eyes, skin and joints (sometimes called “extra intestinal manifestations”).
Signs and symptoms of CD can range from mild to severe. They usually develop gradually, but sometimes symptoms will come on suddenly and without warning. When the disease is active, signs and symptoms may include:
- Abdominal pain and cramping (chronic)
- Diarrhea
- Perianal fistula/abscess
- Fatigue
- Fever
- Reduced appetite and weight loss
Ulcerative colitis
Unlike CD, UC is confined to the large intestine or colon in which the lining of the colon becomes inflamed and develops open sores, or ulcers. There are five types of UC based on location:
- Acute severe UC is a rare form of UC that affects the entire colon and often results in hospitalization
- Left-sided colitis affects the descending colon and rectum.
- Pancolitis affects the whole colon and causes persistent bloody diarrhea.
- Proctosigmoiditis affects the lower colon and rectum.
- Ulcerative proctitis is the mildest form of UC that only affects the rectum.
Common symptoms and signs of UC include:
- Abdominal pain
- Loose stools/diarrhea
- Bloody stool
- Fatigue
- Urgency of bowel movement
- Weight loss
- Loss of appetite
The Use of Biologics in Treating Inflammatory Bowel Disease
Medical treatment for inflammatory bowel disease generally follows a ‘step up’ approach starting with chemical anti-inflammatory agents including aminosalicylate based therapies (mesalamines), corticosteroids, and antimetabolites such as purine analogs (azathioprine and 6-mercaptopurine) and methotrexate. A high percentage of patients fail to respond or are intolerant to these therapies and require treatment with biologic agents (monoclonal antibodies).
Biologic agents have dose regimens that are established from randomized controlled trials and are based on the ‘typical’ or average patient. These regimens are established when the drug is approved and are referred to as ‘labeled dosing’. However, the duration of these trials is typically a year and IBD is a chronic disease. Furthermore, some IBD patients can quickly develop anti-drug antibodies, lessening the effects of the drug and rendering it ineffective. As time passes with a biologic, the likelihood of developing anti-drug antibodies increases.
Biologics with iDose
There is no one right dose for all patients, and every patient requires individualized dosing tailored toward their specific characteristics. To increase the chances of successful drug therapy with Infliximab, Baysient developed the web-based iDose system, which calculates a precise dose and dose interval (time between doses) of Infliximab for inflammatory disease patients.
iDose utilizes Bayesian models, routine lab results, and demographics to individualize dosing to a specified target trough level for each individual patient. Our goal at Baysient is to decrease the failure rate of Infliximab dramatically, increasing the chances that it will continue to work for the patient, year after year.
Start offering your patients an individualized approach to dosing, and help them reach long-term remission. Schedule your demo with the Baysient team today to get started.
