IBD goes home: from telemedicine to self-administered advanced therapies

ABSTRACT

Introduction

Major challenges have been posed by the coronavirus disease 2019 pandemic in the routine management of patients with inflammatory bowel disease (IBD). The need for constant monitoring of diseases activity and prompt adjustment of therapy have been balanced with the risk of contagion related to face-to-face consultations. Therefore, digital health initiatives have been pursued for safety reasons as vicarious instruments to avoid overcrowding of the IBD clinics. However, concerns and skepticism about the feasibility of digital health and telemedicine modalities limited their uptake in clinical practice in the pre-pandemic period.

Areas covered

We conducted a literature overview on the current state of the art and the potential future benefits deriving from the integration of telemedicine systems, home-based laboratory tests, and self-administered drugs into IBD daily practice.

Expert opinion

Digital health and telemedicine approaches at distance have been experimented as effective tools to avoid overcrowding of clinics and reduce risk from SARS-CoV2 exposure. Home-based point of care testing, such as fecal calprotectin and dried blood samples, might represent an effective method of remote monitoring of patients particularly when in-person visits are precluded. High expectations are placed on the use of self-administered advanced therapies, such as new subcutaneous formulation of biologics.

KEYWORDS:

• Inflammatory bowel diseases
• telemedicine
• home-based laboratory tests
• self-administered therapy

Article highlights

• Telemedicine systems showed to be safe, feasible, and cost-effective, reducing geographical disparities.

• Virtual clinics and telemedicine monitoring systems appear appropriate for stable patients, with a well-established treatment plan, and after a shared decision process.

• Home-based point of care with disease activity laboratory tests (e.g. fecal calprotectin) and dried blood samples for drug monitoring are promising despite larger studies are eagerly awaited.

• Self-administered therapy at home showed to meet patients’ needs and convenience. Based on the available evidence, maintenance therapy with the subcutaneous formulations of infliximab and vedolizumab seems an effective and safe strategy.

• Shifting from large hospital centers to a cleaner and more distributed care-network is key for the creation of a value-based healthcare that is compatible with current pandemic background.

This box summarizes key points contained in the article.

Acknowledgment

We thank FIRMAD for support.

Declaration of interest

L Peyrin-Biroulet has served as a speaker, consultant and advisory board member for Merck, Abbvie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Hospira/Pfizer, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, HAC Pharma, Index Pharmaceuticals, Amgen, Sandoz, Forward Pharma GmbH, Celgene, Biogen, Lycera, Samsung Bioepis, Theravance. S Danese has served as a speaker, consultant and advisory board member for Schering-Plough, AbbVie, MSD, UCB Pharma, Ferring, Cellerix, Millenium Takeda, Nycomed, Pharmacosmos, Actelion, Alphawasserman, Genentech, Grunenthal, Pfizer, Astra Zeneca, Novo Nordisk, Cosmo Pharmaceuticals, Vifor and Johnson & Johnson, Nikkiso Europe GMBH, Theravance. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

The authors have no funding to report.