CARE Perspectives on ACG/UEGW 2017 Report

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Members of the CARE Gastroenterology Faculty recently attended the ACG 2017 conference held in Orlando, FL (October 13-18) and the UEGW 2017 conference in Barcelona, ES (October 28 - November 1).

The CARE Perspectives Conference Report from ACG/UEGW 2017 provides a summary of the most compelling stories and news presented at this event, and provides Canadian perspectives from the CARE Gastroenterology Faculty. 

The content that follows is written in the language in which it was presented and is adapted from the abstracts from the ACG/UEGW 2017 meetings. Perspectives are provided by the CARE Gastroenterology Faculty.


CARE Faculty who have contributed to this report:

John Marshall, MD, FRCP(C), AGAF
McMaster University 

Louis Liu, MD, FRCP(C)
University Health Network

Remo Panaccione, MD, FRCP(C)
University of Calgary

CARE Perspectives - The Impact of Biosimilars in Canada

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Dr. John Marshall (McMaster University) and Dr. Vipul Jairath (University of Western Ontario) met at the Farncombe Family Digestive Health Research Institute (McMaster University) during the summer of 2017 to discuss a topic of great interest to the CARE Faculty, as well as practicing Canadian gastroenterologists and physicians around the world – biosimilars. 

Biologics have revolutionized the treatment of inflammatory bowel disease (IBD). Many of the biologics used over the years are reaching their patent expiry, and with this loss of exclusivity, biosimilars have been developed. Biosimilars are relatively new to the Canadian landscape, and there is a lot to learn about their impact and how to effectively integrate them into clinical practice. What follows is a review by Dr. Marshall and Dr. Jairath on how existing and future clinical trials are shaping the use of biosimilars in Canada.

Part 1: What have we learned so far?

Part 2: What trials are underway in Crohn's disease?

Part 3: Where is the landscape headed?

Interested in Biosimilars?
View meeting highlights from CARE's three Regional Congresses on Biosimilars! 

CARE Gastroenterology Guiding Principles on Biosimilars

This initiative is led by: 
Drs. John marshall, Remo Panaccione, Vipul Jairath, MD, & Anthony Otley

The CARE Faculty has been looking at the impact of biosimilars since 2015, given the significance of this topic across both chronic and disease entities. Select CARE Gastroenterology Faculty members have consolidated the following guiding principles based on the collective discussion from past CARE Education initiatives that explored the anticipated impact that the introduction of biosimilars will have in Canada.

Biosimilars have been a topic of interest for various CARE™ Faculties for several years now. To gauge levels of understanding along with perceptions and opinions on the impact that biosimilars will have on the Canadian landscape, a number of CARE faculties conducted needs assessments with their peers. Between 2014-2016, needs assessments were directed at specialists in gastroenterology, rheumatology, oncology, and hematology.

The aim of developing these principles is to provide Canadian health care providers with an overarching view of the positions from the CARE Faculties, which in turn may help inform their treatment decisions. 

CARE Perspectives on DDW 2017

Members of the CARE Gastroenterology Faculty recently attended the DDW 2017 conference held in Chicago, IL (May 6-9, 2017). At this conference, the 9th annual CARE at DDW education meeting was held. Attendees included academic and community specialists, and residents. This meeting brought together a pan-Canadian Faculty of KOLs to showcase cutting edge content in gastroenterology from DDW. Common themes that the CARE Gastroenterology
faculty focused on include:

- Optimization of current therapy

- Innovation that comes with research and new therapy

- Access to treatment

- The potential impact of technology - both from a specialist and patient perspective

The CARE Perspectives Conference Report from DDW 2017 summarizes the presentations of the participating faculty. The content that follows is written in the language in which it was presented and as applicable includes abstracts identified from DDW 2017. Perspectives are provided by the CARE Gastroenterology Faculty. 

For patients with inflammatory bowel disease (IBD), there are several currently available therapies that have helped to improve patient outcomes over the last few years. Emerging, innovative treatments are improving ways of managing patients with IBD and will provide us with more choice and greater treatment flexibility. The CARE Faculty is interested in the views of Canadian gastroenterologists with regards to the impact of new agents in Canada and access to these therapies. We thank you in advance for your valuable feedback! The results from this needs assessment will be shared in future CARE publications.

CARE Perspectives on ECCO/CDDW 2017

CARE (Community. Academic. Research. Education.) believes in: optimization of current therapy, innovation with new treatments, accessibility, and competition; considered in ways that deliver better healthcare solutions to Canadians.

In keeping with these beliefs, this issue of CARE Perspectives explores abstracts and research presented at both the 12th annual ECCO (European Crohn’s and Colitis Organisation) congress held in Barcelona, Spain (February 15-18, 2017) and the CDDW (Canadian Digestive Diseases Week) meeting in Banff, Alberta (March 3-6, 2017).  

This report includes content on inflammatory bowel disease and irritable bowel syndrome, as well as updates on what the CARE Gastroenterology Faculty has been working on. Content is contextualized and framed from a Canadian perspective.  We hope you find this valuable and stay tuned for more gastroenterology updates in 2017!


CARE Treatment Algorithm: The Management of Chronic Constipation

The CARE Gastroenterology Faculty, led by Dr. Louis Liu (UHN), recently developed a treatment algorithm for the management of chronic constipation that was published on February 8th 2017 in the Canadian Journal of Hepatology & Gastroenterology.

Click here for the full publication:

Gastro-Times: The Changing Landscape of Inflammatory Bowel Disease

Introduction :

We are in the golden age of Inflammatory Bowel Disease clinical care. Biologics have revolutionized the treatment of chronic inflammatory conditions in the past two decades, leading to significant improvements in efficacy and manageable safety. In order to ultimately improve patient outcomes, research continues to consider how to optimize the use of current biologic agents (i.e. via dose optimization & therapeutic drug monitoring), drive innovation of new agents, and investigate how increased competition will affect practice, due to the introduction of biosimilars. 

This issue of Gastro-Times will review these three key topics as they apply to the Canadian landscape. In order to provide real-world insight on IBD management, case studies will also be considered for pediatric patients, new patients (biologic naïve), and stable patients.


CARE Gastroenterology Faculty who have contributed to this report :

Dr. John Marshall - McMaster University

Dr. Remo Panaccione - University of Calgary

Dr. Thomas Walters - Sick Kids Hospital


Perspectives de CARE Essai NOR-SWITCH

Les agents biologiques ont révolutionné le traitement des maladies inflammatoires de l’intestin et amélioré la vie des patients de façon significative. Quelques biologiques sur le marché vont perdre leur brevet et d’autres molécules (biosimilaires) sont maintenant en train d’apparaître. L’arrivéedes biosimilaires aura beaucoup d’impact sur notre pratique médicale, sur les budgets alloués et sur la façon dont nous allonsdispenser les soins de santé au Canada.

L’étude NOR-SWITCH est une étude randomisée à double insu qui évalue une cohorte de patients qui avaient une maladie stable avec le biologique innovateur infliximab (REMICADE®). Les patients étaient randomisés soit pour continuer l’infliximab ou soit pour changer à la version biosimilaire de l’infliximab (INFLECTRA® au Canada). Cette étude portait sur des patients adultes avec plusieurs diagnostics dont la maladie de Crohn, colite ulcéreuse, arthite rheumatoïde, spondylarthrite, arthrite psoriasique et psoriasis en plaques. Chaque groupe a été suivi pendant 52 semaines et a été évalué au moyen de paramètres différents selon le groupe.


La version anglaise de cette interview avec Dr John Marshall et Dr Brian Feagan:

CARE Perspectives on the NOR-SWITCH Trial


A Discussion between Dr. John Marshall and Dr. Brian Feagan

Biologic therapy has revolutionized the treatment of IBD and improved patient outcomes drastically. Many of the biologic therapies we routinely use are now or soon going off patent and competitive molecules, biosimilars, are now being introduced. Biosimilars have potential implications for our own practices but also for how we manage our pharmacy budgets and how we deliver health care in Canada.

The NOR-SWITCH trial was a randomized, double-blind trial studying a cohort of patients who were stable on the innovator biologic, infliximab (REMICADE®). Patients were randomized to either continue with infliximab or switch to a biosimilar version of infliximab (INFLECTRA™ in Canada). This was a cross specialty trial that included adult patients from a variety of diagnoses, including:  rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, Ulcerative Colitis (UC), Crohn’s Disease (CD) and chronic plaque psoriasis. Each group was followed for disease worsening as the primary endpoint measured by their respective disease activity indices. 

CARE Gastroenterology Faculty lead, Dr. John Marshall (McMaster University), sat down with Dr. Brian Feagan (Professor of Medicine at the University of Western) to critically assess this study and discuss how the results should be interpreted and applied in Canadian practice. 

The video interview from their conversation is also available below: