A 62-year-old woman with a first episode of ulcerative colitis, who relapsed 4 months after treatment with a systemic steroid; a 36-year-old girl who had always been well after an episode of pancolitis 4 years ago, and experiences a significant relapse experiencing difficulty controlling the disease with cortisone; a 31-year-old undergoing treatment for ulcerative colitis who discovers she is pregnant, interrupts part of the treatments and the day after the birth goes to relapse and, subsequently, also to the failure of anti-TNF therapy; and finally another 30-year-old with Crohn’s disease since she was 25, who goes through various therapies and in 2018 develops a severe relapse and also has to deal with the loss of response to anti-TNF treatment. They are stories of Mici, chronic inflammatory bowel diseases.
Different patients, mostly young. Each with its own needs – the new mother, the worker, the older woman who at the same time deals with other pathologies – but also with something in common: the arrival to therapy with the monoclonal antibody vedolizumab, a biotechnological drug intestinal selectivity, already available in intravenous formulation for the treatment of adult patients with moderate to severe ulcerative colitis or active Crohn’s disease, and now also in the new subcutaneous formulation.
The clinical cases were discussed during the ‘Made for freedom’ event, promoted by Takeda, by a group of experts – Fabrizio Bossa (Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo), Emma Calabrese (University of Rome Tor Vergata, Rome ), Flavio Caprioli (Polyclinic of Milan), Marco Daperno (Mauriziano Hospital of Turin), Fernando Rizzello (Sant’Orsola Malpighi, Bologna) – who reflected on the challenge of managing the various therapeutic options available and adapting them to the characteristics of each patient.
A reflection that also embraces the choice of switching from the mode of administration by intravenous infusion to the subcutaneous one, explored with regard to vedolizumab. A choice that, for example, Daperno would have considered for his 36-year-old patient, and in general “also early enough for patients in which an extra infusion means another day of lost work”. Another issue analyzed: how to optimize the choice of therapies. “We would need disease markers – emphasizes Calabrese – that allow us to better understand how to treat patients before giving them a drug”.
“The fact of having subcutaneous therapies – finally points out Mariabeatrice Principi, University of Bari, moderator of the comparison – shifts attention to compliance”. And perhaps in this, experts reflect, “telemedicine could help us”.
“Even in Crohn’s disease as in ulcerative colitis – they remark – the fact of being able to have maximum elasticity around the patient’s clinical situation, of being able to start with intravenous therapy, continue subcutaneously, not excluding a return to the intravenous if doubt arises. that the patient is not doing the treatment is very important. Here the difference is maximum flexibility, the ability to speed up and slow down when needed. And monitoring is important in order to modulate the methods of administration and know when to do it “.