IBD's Most Persistent Gap and the Potential the Missing Piece: Q&A with Christian Thienel

In 2024, Pharmaceutical Executive reported on a survey that showed a significant number of patients suffering from irritable bowel disease (IBD) struggle to afford proper healthcare. According to the results, treatments became unattainable due to barriers such as financial challenges and insurance issues. Many patients also struggled with adverse health impacts.

At the time, the Crohn's & Colitis Foundation president and CEO Michael Osso said, “These findings underscore the urgent need to address healthcare disparities in IBD care. Despite our progress in IBD research and treatment options, many patients still struggle to access the care they need without facing undue burden. Our survey findings highlight the critical need for reforms to ensure that IBD patients can access the medications they need without undue financial hardship."

Recently, Pharmaceutical Executive spoke with Christian Thienel, director at Back Bay Life Science Advisors, about the ongoing issues with IBD treatments. While the original survey focused more on the financial barrers, Thienel’s conversation looked at treatment and R&D barriers which allow for persistent unmet needs to impact patients.

Pharmaceutical Executive: What significant umet needs remain in IBD treatment?
Christian Thienel: You might assume that with the number of therapies available, this is a relatively well-served market. But one of the most consistent findings from our research is that it isn't. There are therapies that can induce clinical remission after initial treatment — but durability of remission remains a significant unmet need. A large number of patients are still cycling through multiple therapies, which is itself a signal that new mechanisms of action and new delivery methods are needed. Having additional options remains important precisely because durable efficacy continues to be a challenge.

If a patient with IBD has tried three or four different biologics or advanced therapies and hasn't achieved sustained remission, there are essentially no remaining options that physicians can confidently recommend at this point. So there is still considerable room to improve on efficacy — and specifically on rates of durable clinical remission.

We're also seeing growing interest in mucosal healing as a distinct therapeutic goal. As I mentioned earlier, single cytokine approaches are effective at reducing inflammation and producing an initial response. But there is a growing perception among GI KOLs — and I'll acknowledge this is somewhat speculative — that addressing mucosal healing more directly, including restoring barrier function and addressing elements of the disease that aren't as directly targeted by individual cytokines, could be the key to achieving more durable responses and meaningfully improving patient quality of life. Those components of the disease state are increasingly seen as important, and they remain underaddressed by the current standard of care.