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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. May 6, 2017; 8(2): 114-119
Published online May 6, 2017. doi: 10.4292/wjgpt.v8.i2.114
Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment
Giovanni C Actis, Rinaldo Pellicano
Giovanni C Actis, Rinaldo Pellicano, the Medical Center Practice Office, 10129 Torino, Italy
Giovanni C Actis, Hepatogastroenterology Division, Ospedale Gradenigo, Corso Regina Margherita, 10153 Torino, Italy
Rinaldo Pellicano, Unit of Gastroenterology, Ospedale Molinette, 10126 Torino, Italy
Author contributions: Actis GC and Pellicano R shared responsibility in study design, manuscript development, and literature search; Pellicano R double-checked the references and formatted the paper.
Conflict-of-interest statement: The authors declare no potential conflicts of interest and no financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Giovanni C Actis, MD, the Medical Center Practice Office, 10129 Torino, Italy. actis_g@libero.it
Telephone: +39-011-591388 Fax: +39-011-505564
Received: July 27, 2016
Peer-review started: July 29, 2016
First decision: October 20, 2016
Revised: October 28, 2016
Accepted: January 11, 2017
Article in press: January 13, 2017
Published online: May 6, 2017
Abstract

The inflammatory bowel diseases (IBD) are chronic incurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mild-moderate colitis, and do not work in Crohn’s; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn’s; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically (not monitored) causing further increase of their cost over that of hospitalization. Against all these caveats, two simple rules still hold true: Strict adherence maintenance and avoidance of colitogenic drugs. This matter is expanded in this minireview.

Keywords: Inflammatory bowel disease, Therapy, Cost containment, Budget, Treatment adherence, Inflammatory bowel disease managed care

Core tip: Cost-effective maintenance of remission of inflammatory bowel diseases (IBD) is a traditionally unsolved challenge for care-takers and budget supervisors. The newly released (biologic) formulations, though purported to act as disease terminators, have failed to pay back their initial cost. We have faced the issue by reappraising initial simple tenets and found the following: (1) usually, uncomplicated IBD rests in remission by using cheap traditional drugs, provided the indication is correct, and, chiefly, that adherence is tightly maintained. Non compliant IBD patients cost manifold the compliant ones, and are the main cause of budget distortion; and (2) third-party drugs (nonsteroidal anti-inflammatory drugs, e.g., should be avoided. A frozen steady-state is the regime to effectively maintain IBD.