BEST HEALTH OUTCOMES SHOULD DETERMINE TREATMENT DECISIONS
Liam McMaster understands the long and arduous journey toward reclaiming a reasonable quality of life when battling Crohn’s disease. For him, like many others with Crohn’s disease or ulcerative colitis, the path toward alleviating debilitating symptoms led him and his doctor to biologic treatment.
McMaster learned he has Crohn’s disease shortly after his 20th birthday. He had noticed his energy dwindling while discomfort – including stomach pains and headaches – increased. A university student at the time, he found it challenging to continue his routine of staying physically active, going to lectures and handing in assignments that reflected his best work.
Eventually, his gastroenterologist prescribed a biologic treatment that “started a process of healing,” says McMaster. “Every symptom virtually vanished. Now, my inflammation level is normal. I gained back the 20 pounds I had lost. I am also back to playing tennis and training with weights.”
His treatment regime has enabled McMaster to reclaim his quality of life. He was able to work abroad for a time and is now looking forward to starting a consulting career. Given the effectiveness of his medication and the long path toward relief, McMaster, a resident of Ontario, is alarmed that governments across Canada are considering changes to treatment of patients like him, without the approval of doctors.
In British Columbia, for example, people living with Crohn’s disease or ulcerative colitis, the two main forms of inflammatory bowel disease (IBD), face the prospect of being switched from biologic to biosimilar medication for non-medical reasons. While biosimilars are highly similar to their original biologic drug, they are not identical.
A switch decided by government is “very worrying,” says McMaster. “The [biologic] medication enables me to lead a normal and productive life. If the treatment plan changes, there are no guarantees I stay in remission.”
Mina Mawani, president and CEO of Crohn’s and Colitis Canada, the national, volunteer-based charity focused on finding the cures for Crohn’s disease and ulcerative colitis and improving the lives of everyone impacted by these diseases, says, “We echo Liam’s concern about a non-medical switch policy that would potentially affect the hundreds of thousands of Canadians with Crohn’s and colitis across our country. Crohn’s and Colitis Canada, together with the Canadian Association of Gastroenterology, reviewed all available evidence and concluded that non-medical switching of patients like Liam, well-managed on a biologic, is not in their best interest. Gastroenterologists do not support non-medical switch policy and share the concern of our patient community.”
Crohn’s and Colitis Canada has been gathering information for government health-care decision-makers for some time, says Mawani. “We’ve brought together the perspectives of patients, caregivers, gastroenterologists and IBD nurses, considered the legal and ethical ramifications, consulted widely with renowned experts and have considered the latest scientific evidence. We have provided all of this to governments across Canada to demonstrate that a non-medical switch is not OK for patients with IBD, and we are supported by the doctors treating these patients.”
Crohn’s and Colitis Canada and the Canadian Association of Gastroenterology produced a Joint Statement on biosimilars in October 2019.
“We understand the need for governments to be fiscally responsible, and agree that biosimilars are a safe and effective treatment for people with Crohn’s or colitis. That said, the cost savings purported to be the reason behind a non-medical switch policy have been disproven,” stresses Mawani. “And much more importantly, patient health is at stake. Patients and their doctors need to be the ones deciding on treatment. Not the government.”
Paul Moayyedi, Audrey Campbell Chair of Ulcerative Colitis Research at McMaster University and co-author of the Joint Statement, adds, “Given how serious IBD is, governments should not be mandating medication switches on patients without evidence to support what they are doing. Evidence shows that those who are switched [to a biosimilar] have a 30 per cent greater chance of their disease worsening.”
Crohn’s and Colitis Canada is committed to supporting people like Liam with IBD across the country and will continue to share information with health-care decision-makers in all provinces and territories to inform patient-centred policy. Says Mawani, “Our focus is on patients – their health and well-being are our priority.”
McMaster also applauds Crohn’s and Colitis Canada’s efforts on behalf of the patients potentially affected by a switch from a biologic to a biosimilar. He says, “When you take away a treatment your body responds to so well, you are limiting your options for keeping the inflammation under control in the future. It is a frightening prospect.”
Crohn’s and Colitis Canada invites Canadians to let local government know that they think treatment decisions should be between patients and their doctors: action.crohnsandcolitis.ca/choice.
For more stories from this feature, visit globeandmail.com