Small-molecules expand therapeutic options for IBD patients 

Small-molecule drugs are beneficial to patients with IBD, however more data is needed around the treatment, the ISG/USG Summer Meeting heard. 

Consultant Gastroenterologist at the University Hospital Leuven in Belgium, Prof Séverine Vermeire, delivered a virtual presentation at the ISG/USG Summer Meeting. After two decades of using biological drugs (biologics) to treat inflammatory bowel disease (IBD), small molecule drugs are now entering the therapeutic landscape, according to the Professor. 

“For me, they are very welcome additional treatment options that I think are really great assets for our patients with IBD,” she said. 

When comparing small molecule drugs with biologics, Prof Vermeire said: “I think it’s fair to say that all of these agents are in the same efficacy range, [as] our biologics. Are they worse? Certainly not. Are they better? I think we cannot say at the moment.” 

According to Prof Vermeire, there is a lack of data comparing small molecules and biologics. 

“We do not have head-to-head trials comparing our small molecules with biologics,” she said. “We also lack meta-analyses. We have no, or very few, real-world data. 

“I think all of these will be needed in the coming years to help us [in] positioning these agents.” 

However, Prof Vermeire highlighted some progress being made towards gaining more information. 

For example, a 2022 study in the Clinical Gastroenterology and Hepatology journal, found tofacitinib, a small molecule drug, was more effective than vedolizumab, a biologic. 

“I think it’s a whole combination of real-world data, personal experience, getting comfortable with the medication, and then balancing the benefits and the risks,” Prof Vermeire said. “And you really need to consider the individual patient profile.” 

To conclude her presentation, Prof Vermeire gave her personal opinion on what could be considered the ‘perfect’ ulcerative colitis patient to receive small molecule drugs. 

They would be a compliant male or female (who should have no imminent wish for pregnancy); they should also be fit; and preferably under 60 years old. They can be biologic-naive, but can also have taken anti-tumour necrosis factor (anti-TNF) drugs prior. 

“I think we should prescribe them [small molecules] as a monotherapy,” the professor concluded. 

All-Ireland Gastroenterology, Summer Meeting (ISG/USG), Europa Hotel, Belfast, 9-10 June 2022.