Call Me Anything but Thoughtless or Misguided in IBD Management
I read with interest the open access, original article, by S.K. Murthy, et al, Introduction of anti-tumor necrosis factor therapy has
not yielded expected declines in hospitalization and intestinal resection rates in
inflammatory bowel diseases: a population-based interrupted time series study
appearing in Gut 12 June 2019.
It must first be stated that the authors are to be congratulated for the magnificent
demonstration of the benefits of the Canadian healthcare system in terms
of collection of healthcare data.
That said, I take issue with their explanation and hypothesis: “misguided use and failure to optimize use of infliximab, particularly among patients with Crohn’s Disease
(CD), as well as possible underuse of infliximab among patients
with ulcerative colitis (CUC)….” In the follow-up press release,
one summary recommendation was that “doctors should be more thoughtful in managing inflammatory bowel disease (IBD).”
It is unfortunate, indeed, that the term “misguided use” would appear and then be
translated into perhaps a deeper, and unwarranted, criticism that
doctors managing IBD have been “less than thoughtful or misguided” in the use of biologics.
I think the authors actually intended
to report that the academic community has collected clinical trial
data and offered practicing clinicians a plan for use of biologics
only to find in retrospect that those recommendations were not
likely to be effective given the general IBD patient population and
the less than complete effectiveness of the biologics. Nonetheless,
the message was certainly blurred.
Gastro Open J. 2019; 4(1): 4-6. doi: 10.17140/GOJ-4-129