After years of painful and, sometimes, embarrassing ‘toilet-dependency’, many patients with inflammatory bowel disease (IBD) will face life-changing surgery. 

"Surgery for hard-to-treat IBD could be followed by life with an ostomy bag."

In the UK around 300,000 people suffer from IBDs such as Crohn’s disease and ulcerative colitis, life-long conditions that can cause symptoms including diarrhoea, pain, cramps or bloating. The hardest-to-treat IBD requires surgery to remove damaged bowel – which, in some patients, is followed by life with an ostomy bag.

 

Treatment devotees

 

Two types of biologic treatment are currently available for people with IBD, but because of cost these are generally a last resort. However, drug treatment can be effective, providing years of quality life, and it has significantly reduced the surgical queues. It has also inspired a number of patient devotees: so much so, in fact, that, according to gastroenterologist and chair of the IBD section of the British Society of Gastroenterology Dr Barney Hawthorne, patients have cried when their consultant talks about taking the drugs away.

"Costs mean biologic drugs are a last resort - patinets have cried when consultants take them away."

Two years ago, added competition from biosimilars approved by medicines watchdog NICE for ulcerative colitis as well as Crohn’s “lifted the lid off the use of these drugs”, says Dr Hawthorne, who says that prices have tumbled with a huge increase in IBD patients being offered these drugs. “We are now able to treat more than twice the number of patients for the same cost as one taking a biologic. Many patients will stay on these drugs for years.”

 

New options for the hardest to treat

 

With new drugs for IBD due to come to market in around 18 months’ time, Dr Hawthorne is optimistic that these will introduce more non-surgical solutions for the many people with IBD who fail to benefit from currently available drugs, or in whom the benefits of drug treatment wane over time.

“Soon the NHS will be able to use these drugs when it needs to, and not just when it can afford to."

The introduction of new lower-price options offering better targeted, more personalised treatment, and much earlier in the treatment pathway, will provide real alternatives for hard-to-treat IBD. Coupled with better information for prescribers on the real-time experience of use, these drugs, he says, have the “potential to change lives”.

“The day is coming when the NHS will be able to use these drugs when it needs to, and not just when it can afford to. And that’s really exciting.”