The 2023 Impact of Inflammatory Bowel Disease in Canada: Treatment Landscape

Abstract The therapeutic landscape for inflammatory bowel disease (IBD) has changed considerably over the past two decades, owing to the development and widespread penetration of targeted therapies, including biologics and small molecules. While some conventional treatments continue to have an important role in the management of IBD, treatment of IBD is increasingly moving towards targeted therapies given their greater efficacy and safety in comparison to conventional agents. Early introduction of these therapies—particularly in persons with Crohn’s disease—combining targeted therapies with traditional anti-metabolite immunomodulators and targeting objective markers of disease activity (in addition to symptoms), have been shown to improve health outcomes and will be increasingly adopted over time. The substantially increased costs associated with targeted therapies has led to a ballooning of healthcare expenditure to treat IBD over the past 15 years. The introduction of less expensive biosimilar anti-tumour necrosis factor therapies may bend this cost curve downwards, potentially allowing for more widespread access to these medications. Newer therapies targeting different inflammatory pathways and complementary and alternative therapies (including novel diets) will continue to shape the IBD treatment landscape. More precise use of a growing number of targeted therapies in the right individuals at the right time will help minimize the development of expensive and disabling complications, which has the potential to further reduce costs and improve outcomes. Lay Summary This article reviews studies on treatment for inflammatory bowel disease (IBD). IBD is a disease that causes the bowels to become inflamed. Many treatment options exist for people with IBD in Canada. Some of these options are drugs, surgery and diet. Many drugs used to treat IBD are very expensive. New biosimilar drugs may lower costs and increase how available these drugs are. It is very important to make sure that the right drug for the right person at the right time is found. New studies must seek to understand what the right treatments are for each person. We have come a long way in treating IBD over the last 60 or so years. However, people with IBD may still need surgery at some point. New drugs being tested offer hope that more ways to treat IBD will soon be available. We hope that these new drugs will prove safe an effective for people with IBD and reduce complications of disease.