Biological Therapy Penetration for Inflammatory Bowel Disease in Latin America: Current Status and Future Challenges

Abstract

BACKGROUND: The introduction of anti-TNF agents represented a landmark in the management of both Crohn’s disease (CD) and ulcerative colitis (UC), with improved efficacy and safety when compared with conventional treatment. However, significant challenges still exist in Latin America to facilitate the access of biological agents for physicians and patients. OBJECTIVE: The aim of this review was to summarize current evidence on penetration of biological agents for CD and UC in Latin America. METHODS: Data are derived from a previous complete systematic review that explored different characteristics of inflammatory bowel diseases (IBD) in Latin America. The studies fully included in this previous systematic review which contained detailed descriptions of the percentage of use of biological agents in different cohorts throughout Latin American and Caribbean countries were included, and descriptive findings were compiled, describing CD and UC penetration of these drugs in different patient cohorts from different countries. RESULTS: From the 61 studies included in the original systematic review, only 19 included data of the percentage of patients treated with biological agents. Anti-TNF use in CD varied from 1.51% in Mexico up to 46.9% in Colombia, with most of the studies describing anti-TNF use in approximately 20%-40% of CD patients. On the other side, the frequency of the use of biologics was clearly lower in UC, varying from 0% in 2009 to up 16.2% in 2018, according to two different Mexican studies. Only two studies described the penetration of anti-TNF agents in IBD overall: 13.4% in a Colombian and 37.93% in a Brazilian study. No studies described percentage of use of new biologic agents (vedolizumab and ustekinumab). CONCLUSION: Penetration of anti-TNF agents in Latin America is comparable to the rest of the world in CD, but lower in UC. With the increase in the incidence and prevalence of IBD, specific strategies to increase access to anti-TNF agents in UC and new biological agents overall are warranted.

Correlation of serum levels of anti-tumor necrosis factor agents with perianal fistula healing in Crohn’s disease: a narrative review

“…Currently, the management with intensive medical therapy (usually with anti-TNF agents as first line) and surgical drainage with curettage of fistula tracks and seton placement represents the best strategy to manage this difficult phenotype of the disease, and is recommended by most guidelines. 12,49 The principle of this combination management is targeted towards rectal mucosal healing and reduction of inflammation in fistula tracks, what can close fistulas in approximately 50% of patients. Once there is no rectal or local inflammation, and the fistula still persists, additional surgical procedures, such as advancement flaps, ligation of fistula tracks, among others, can be indicated.…”

“…Combination therapy with the use of biologics and surgical manipulation of fistula tracks, with sepsis eradication and seton placement, currently represents the best treatment strategy for PFCD. 12 This strategy can lead to long term fistula closure when compared to surgical treatment alone. 13 More recently, evidence demonstrated that higher serum levels of anti-TNF agents can be associated to better outcomes in CD, such as higher rates of clinical remission and mucosal healing.…”

Review of the epidemiology and burden of ulcerative colitis in Latin America

“…A recent review emphasised that the biologic penetration in treatment algorithms in Latin America is adequate in Crohn's disease, but lower in UC. 43 Therefore, the data from the private IBD centre in Mato Grosso do Sul, Brazil reflects a unique perspective on the continent and does not represent the reality observed in studies across different countries. 19 In contrast, conventional therapies (5-aminosalicylates, corticosteroids, immunosuppressants) were generally the most widely utilised.…”

Research in inflammatory bowel disease in Brazil: a step forward towards patient care

“…Brazil is one of the largest countries in the world. Over the last decades, the incidence and prevalence of IBD seem to be increasing in our country, in a profile that seems different than other Latin American countries (7,8) . As compared to countries such as Colombia, Mexico, and Argentina, the UC:CD ratio in Brazil is proximal to one in different areas of the federation, a similar disease distribution as countries from North America and Europe (9) .…”