Millie Long, MD: Initial Takeaways From TARGET-IBD

In an interview at ACG 2019, Millie Long, MD, MPH, FACG, associate professor of medicine at the University of North Carolina, Chapel Hill, shares initial updates from the ongoing TARGET-IBD study.

Long: TARGET-IBD is a really exciting project to be a part of. It's a multi-center, real world cohort and, in inflammatory bowel disease, it's very important because so many of the trials that brought our drugs to market were very restricted populations. We really need to understand how drugs are used out in the real world and in the community, understand things like efficacy, understand things like side effects. This cohort is very unique in that it includes a large number of community sites as well as academic sites; we're trying to get a handle on how inflammatory bowel disease is treated throughout the country.

To date, this cohort has almost 3000 patients enrolled so we're very excited that, hopefully, over the next 3 to 5 years we're going to have some great outcome data in regard to comparative effectiveness of various agents and in various populations of inflammatory bowel disease patients.

What we're presenting here at ACG are 2 abstracts that looked at some of the initial data—the data at enrollment. Specifically, the US Food and Drug Administration is very interested in how our medications are used in elderly populations and whether or not those practice patterns differ, whether how long patient stay on medications differ, side effects differ, better understanding of co-morbidities of patients in that older age group because many of them may not have been included in the randomized controlled trials that brought these drugs to market.

We presented data on differences between elderly populations as compared to younger populations with inflammatory bowel disease in regards to specific medical therapies. We found that biologic agents weren't used as frequently in older individuals. I think some of that is safety concerns but, unfortunately meds like prednisone actually have much more concerning safety signals and we did see a high amount of prednisone use. I think a better understanding of how these drugs are used in elderly populations and potentially some educational interventions can be very important.

We also, from this cohort, presented some data on mesalamine use. We looked at data prior to the American College of Gastroenterology guidelines that came out that actually recommended against the use of mesalamine in Crohn's disease. Mesalamine is a very effective agent for the treatment of ulcerative colitis, but in Crohn's disease we just don't have the same level of efficacy data. And so with this statement of recommend against, we wanted to look at whether or not any practice patterns had changed. Did this guideline actually influence care? And what we found, interestingly, was that there was really no change based on data prior to the guidelines and then data after in terms of rates of mesalamine use. There's still a great deal of mesalamine use in Crohn's disease populations, and so a better understanding of why that is and potentially could there be better, more efficacious for those patients?

The studies, "Oral Mesalamine Use in Crohn's Disease After Implementation of the American College of Gastroenterology Guidelines: A TARGET-IBD Cohort Study" and "Medication Use and Comorbidities Among Elderly as Compared to Younger Patients With Inflammatory Bowel Disease in the TARGET-IBD Cohort," were presented at ACG 2019 in San Antonio, Texas.