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The 2023 Impact of Inflammatory Bowel Disease in Canada: Treatment Landscape.

Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada. Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada. Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. ICES, Toronto, Ontario, Canada. Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada. Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada. Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. Crohn's and Colitis Canada, Toronto, Ontario, Canada. Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Department of Gastroenterology and Hepatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Department of Neuroscience, McGill University, Montreal, Quebec, Canada. Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital Melbourne, Parkville, Australia. Department of Medicine, Memorial University of Newfoundland, St John's Newfoundland, Canada. Department of Interdisciplinary Science, McMaster University, Hamilton, Ontario, Canada. Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Colombia, Canada.

Journal of the Canadian Association of Gastroenterology. 2023;(Suppl 2):S97-S110
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Abstract

The therapeutic landscape for inflammatory bowel disease (IBD) has changed considerably over the past two decades, owing to the development and widespread penetration of targeted therapies, including biologics and small molecules. While some conventional treatments continue to have an important role in the management of IBD, treatment of IBD is increasingly moving towards targeted therapies given their greater efficacy and safety in comparison to conventional agents. Early introduction of these therapies-particularly in persons with Crohn's disease-combining targeted therapies with traditional anti-metabolite immunomodulators and targeting objective markers of disease activity (in addition to symptoms), have been shown to improve health outcomes and will be increasingly adopted over time. The substantially increased costs associated with targeted therapies has led to a ballooning of healthcare expenditure to treat IBD over the past 15 years. The introduction of less expensive biosimilar anti-tumour necrosis factor therapies may bend this cost curve downwards, potentially allowing for more widespread access to these medications. Newer therapies targeting different inflammatory pathways and complementary and alternative therapies (including novel diets) will continue to shape the IBD treatment landscape. More precise use of a growing number of targeted therapies in the right individuals at the right time will help minimize the development of expensive and disabling complications, which has the potential to further reduce costs and improve outcomes.

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Publication Type : Review

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