Holistic immunology: Supporting patients at every stage of their journey

As part of our series from leaders at Janssen, the company’s Max Pahlow looks at how approaches to inflammatory diseases are evolving and what the industry can do to improve things for patients even further.

If I said to a member of the public that I work to improve the lives of people with an IMID (immune-mediated inflammatory disease), they might look at me with a blank expression. Unfortunately, it is perhaps only the terminology that’s unfamiliar, as IMIDs affect between 56–70 million people in Europe alone. And if I said ‘autoimmune diseases’ instead of IMIDs, I’m sure there would be greater understanding and maybe even one or two conditions named.

Psoriasis, rheumatoid arthritis and inflammatory bowel disease (IBD) are all examples of the damage manifested by the battle within – when the inflammatory processes designed to protect us fail to carry out their mission.

From an unbalanced or dysregulated immune response, to the immune system actively attacking the patient’s own tissues, autoimmune conditions have many pathophysiologies. And, as the world’s population grows and our diagnostic capabilities improve, the number of those suffering is on the increase.

The burden of IMIDs

The full impact of IMIDs goes much further than just the physical symptoms. Stigma, isolation, and psychological issues are all too common. IMIDs can have a significant effect on a person’s self-esteem, comfort in social situations, and even their risk of suicide. And around every patient, there are social, emotional and financial ripples that reach out to those who love and care for them.

So, we must ensure that the expansion of treatment options continues to mirror the expansion of the patient population. Two decades ago, Janssen introduced an anti-tumour necrosis factor medication – a type of biologic – that is still widely used today, and we have been building on our commitment to alleviate suffering in IMIDs ever since. While progress varies between IMIDs, new treatment options for conditions like psoriasis need to offer patients levels of efficacy that can be sustained over many years.

But the medicine alone is often not enough. What can add full value is the wrap-around support provided in addition to a specific treatment option, so it’s important to help healthcare professionals (HCPs) understand where such support is available. And while today’s treatments have made a big difference to the lives of many patients, there’s an ongoing need for holistic therapies that go beyond just providing an effective medicine.

We believe the key lies in understanding why IMIDs occur. Some IMIDs share inflammatory pathways that have become poorly regulated, and this presents an opportunity to develop drugs that could be used to treat multiple conditions.

Our approach of exploring new and different mechanisms of action has led us to investigate the use of biologics in multiple clinically distinct IMIDs, one example being in IBD. And it’s a process we aim to follow throughout our pipeline.

Innovating for patients with IBD

It’s essential to understand the day-to-day challenges people face when living with IBD, so we can provide patients and HCPs with a range of treatment options and initiatives. We need to not only address therapeutic needs, but also help people become as informed as possible and minimise the daily impact of their disease.

For example, newly diagnosed patients can be confused and worried by the prospect of managing a chronic disease – so for the past six years, we have collaborated with the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA) to develop the ‘My IBD Journey’ animation series. This initiative offers practical advice to patients about living well with IBD, and tackles topics such as work life, relationships and pregnancy.

Likewise, comprehensive disease management is challenging for patients and their care teams. In 2016, we began developing a potential solution, working closely with patient associations, scientific committees and advisory boards.

Partnering with BePatient, a leading digital health team, we created an app and web portal called Care4Today IBD, which allows patients to monitor their condition through regular questionnaires on factors like weight, bowel movements, and levels of pain and fatigue. Care4Today IBD also integrates an at-home inflammation marker test, allowing patients to upload the test results to the app. This information, together with the results of the questionnaires, is relayed to HCPs for remote assessment. Ultimately, Care4Today IBD aims to increase the patient’s understanding of their disease, and enhance the interaction between patient and HCP.

Ongoing battle

The overall aim of IBD treatment is to control the asymptomatic inflammation of the gastrointestinal tract before it leads to irreversible, long-term damage – and IBD medicines are typically administered according to generic characteristics such as age, sex, and weight.

However, the industry also needs to evaluate proactive and personalised treatment strategies for patients with the aim of tackling IBD before symptoms take hold.

Our hope is that, eventually, it will be common practice for patients to reside in their own ‘goldilocks’ treatment zone; with just enough intervention to control their condition, while also limiting the inconvenience of monitoring and treatment administration, and potential side effects, as far as possible.

There is, of course, still much left to do. It’s crucial to continue the drive for innovation and development of, and access to, treatment options for IMIDs, and support patients at every stage of their journey.

The vision, as lofty as it may seem, is of a day when the internal battle is finally over and all IMID patients can enjoy a lasting peace.

About the author

Max Pahlow is vice president & regional commercial strategy leader (EMEA) of immunology & CVM (cardiovascular & metabolism) for the Janssen pharmaceutical companies of Johnson & Johnson. Since joining Johnson & Johnson in 2002, Max has worked in a range of senior positions, including marketing, government affairs & communications, and commercial and general management.