Treatment of inflammatory bowel disease-Asian perspectives: the results of a multinational web-based survey in the 8th Asian Organization for Crohn's and Colitis meeting

Abstract

Background/aims: As the characteristics of inflammatory bowel disease (IBD) differ between Asians and Westerners, it is necessary to determine adequate therapeutic strategy for Asian IBD patients. We evaluated the current treatment of IBD in Asian countries/regions using a web-based survey.

Methods: The Korean Association for the Study of Intestinal Diseases conducted a multinational web-based survey for current IBD care in Asia between September 16, 2020, and November 13, 2020.

Results: A total of 384 doctors treating IBD patients from 24 Asian countries/regions responded to the survey. Anti-tumor necrosis factor (TNF) agents, anti-integrins, and anti-interleukin-12/23 agents were available for use by 93.8%, 72.1%, and 70.1% of respondents in Asian countries/regions. Compared with a previous survey performed in 2014, an increased tendency for treatment with biologics, including anti-TNF agents, was observed. In the treatment of corticosteroid-refractory acute severe ulcerative colitis, 72.1% of respondents chose anti-TNF agents, followed by tacrolimus (11.7%). In the treatment of corticosteroid-refractory Crohn's disease, 90.4% chose anti-TNF agents, followed by thiopurines (53.1%), anti-interleukin-12/23 agents (39.3%), and anti-integrin agents (35.7%). In the treatment of Crohn's disease patients refractory to anti-TNF agents, the most preferred strategy was to measure serum levels of anti-TNF and anti-drug antibodies (40.9%), followed by empiric dose escalation or shortening of dosing intervals (25.3%).

Conclusions: Although there were some differences, treatment strategies for patients with IBD were mostly similar among Asian doctors. Based on the therapeutic outcomes, it is necessary to identify the most appropriate therapeutic strategy for Asian IBD patients.

Keywords: Asia; Inflammatory bowel diseases; Survey; Treatment.

Fig. 1.

Treatment strategy in Asian patients with inflammatory bowel disease. Analysis of answers to the following questions: “Which strategy will be chosen for mild to moderate UC?,” “Which strategy will be chosen for severe UC?,” and “Which strategy will be chosen for CD?” UC, ulcerative colitis; CD, Crohn’s disease.

Fig. 2.

Second-line therapy in patients with corticosteroid-refractory acute severe ulcerative colitis (UC). Analysis of answers to the question, “Which of the followings would you consider as second-line therapy for acute severe UC patients who fail to improve on intravenous corticosteroids?” JAK, Janus kinase.

Fig. 3.

Treatment of corticosteroid-dependent and corticosteroid-refractory ulcerative colitis (UC). Analysis of answers to the following questions: “Which of the followings would be your first choice for corticosteroid-dependent UC? (multiple choices)” and “Which of the followings would be your first choice for corticosteroid-refractory UC? (multiple choices)” JAK, Janus kinase.

Fig. 4.

Treatment of Crohn’s disease (CD) according to disease location and disease activity. Analysis of answers to the following questions: “Which of the followings would you use for the first induction therapy in mild to moderate inflammatory small bowel CD (with or without colonic involvement)?,” “Which of the followings would you use for the first induction therapy in mild to moderate inflammatory colonic CD (without small bowel involvement)?,” “Which of the followings would you use for the first induction therapy in moderate to severe inflammatory small bowel CD (with or without colonic involvement)?,” and “Which of the followings would you use for the first induction therapy in moderate to severe inflammatory colonic CD (without small bowel involvement)?” 5-ASA, 5-aminosalicylic acid; TNF, tumor necrosis factor; IL, interleukin.

Fig. 5.

Treatment of non-responders to anti-TNF agents in patients with Crohn’s disease. Analysis of answers to the question, “How would you treat non-responders to anti-TNF therapy?” TNF, tumor necrosis factor; IL, interleukin.

Fig. 6.

Combination therapy of anti-tumor necrosis factor (TNF) agents in patients with Crohn’s disease (CD). Analysis of answers to the following questions: “How often do you use thiopurines in combination with anti-TNF agents rather than anti-TNF monotherapy for induction of remission in thiopurine-naïve inflammatory CD?” and “How long would you use combination therapy with anti-TNF agents and thiopurines for induction of remission?”

Fig. 7.

Monitoring tools of disease activity in the treatment of Crohn’s disease (CD). Analysis of answers to the question, “What would you use for monitoring disease activity during the treatment of CD? (multiple choices).” CT, computed tomography; MR, magnetic resonance; US, ultrasound.