Benjamin Click, MD, staff gastroenterologist, the Cleveland Clinic, discusses the process to select the right biologic for a patient with inflammatory bowel disease (IBD).
I think we'd be remiss not to acknowledge the third party in the room when a physician and a patient are interacting and making treatment decisions, and that's the payer in the mix. Unfortunately, a lot of our decisions in medicine do have some payer implications in what a person's insurance will or won't cover. And so that's certainly a consideration when we talk about patients, so there is access impact with regards to what the payer will cover.
From an individual patient decision-making process, there are a lot of considerations that go into how we choose which biologic medication to use. So first is the efficacy. What do we think this particular biologic will do to the disease process itself? Then we talk about risks. What are the risks with each biologic medication? And there's several different classes. We talk about risk of infections, risk of malignancy, risk of potential rejection of the medication by the body over time. And…we talk about the dosing strategy of each medication because they all do differ in some way, shape, or form.
And so generally, when I'm talking to a patient, we talk about their individual disease state. We also talk about what do I think will happen with their disease if left under or untreated over time, and how do we kind of find the common avenue with regards to all those different factors and choosing a biologic medication, and of course, recognizing that we also have to consider which will be covered from an insurance standpoint.