The official strap-line of the Annual Congress of European Crohn’s & Colitis Organisation (ECCO) was ‘Embracing Diversity in IBD’. After speaking with many delegates at the conference, a more appropriate strap-line may well have been ‘Making the Most of What We’ve Got’.
There were several presentations and symposia that focused heavily on optimizing currently available conventional drugs in Crohn’s disease and ulcerative colitis. Interestingly, a number of presenters voiced the opinion that the excitement about biologic therapy use had meant that valuable options had been overlooked and the time to re-visit these drugs were long overdue.
Presentations touched on strategies and techniques that doctors could use to increase the effectiveness of conventional strategies.
For 5-ASAs, the focus was exclusively on ulcerative colitis with strategies that could be grouped loosely into three areas: new preparations for localized delivery, such as Salofalk (mesalazine); improving adherence through once-daily vs. split dosing strategies; and dose optimization in the maintenance setting based on endoscopic monitoring.
Treatment approaches that incorporated localized release of corticosteroids also seemed to generate interest. Discussion focused on using budesonide for longer periods of treatment, especially in patients with steroid-dependent Crohn’s disease and ulcerative colitis. Budesonide’s use in combination with 5-ASA in ulcerative colitis who have failed previous 5-ASA therapy was also discussed.
Monitoring strategies for azathioprine were also featured heavily, with newer approaches to optimize dosing suggested to replace traditional weight-based algorithms. The traditional approach has now been shown to be a poor predictor of response and likely withdrawal.
While not the most ground-breaking presentations at the conference, they did highlight a growing commitment among gastroenterologists to maximize all options before reaching for biologics. As one delegate put it: “We’re not awash with biologic options; it’s only right we make the most of the conventional therapies we have!”