With the increased availability of treatments for inflammatory bowel disease, patients can achieve longer periods of remission, said Vipul Jairath, a gastroenterologist at the London Health Sciences Centre and professor of medicine at Western University, during Benefits Canada’s 2024 Chronic Disease at Work conference in February.
IBD involves an underlying pathological process that creates inflammation of the bowels and lead to ulceration and damage. The disease can sometimes require surgeries and can lead to complications like anemia and joint problems.
Read: Webinar coverage: Innovative new treatments can lead to better outcomes, reduce side-effects in IBD
Roughly 330,000 Canadians are currently living with IBD, which is evenly split between the two types of the disease, Crohn’s disease and ulcerative colitis. While ulcerative colitis involves inflammation of the surface of the bowel, Crohn’s disease can affect the entire gastrointestinal tract. Both are chronic conditions and typically involve periods of remission followed by flare-ups of the condition, though Jairath said in some cases, patients don’t respond to treatments and experience continuous symptoms. People are typically diagnosed in their teens and 20s.
Many studies have found that IBD can disrupt people’s productivity and ability to work, which can be due to a symptom flare-up or appointments and procedures related to the disease. According to a study commissioned by Crohn’s and Colitis Canada, 46.6 per cent of people with active IBD experience absenteeism, 94.8 per cent experience presenteeism and nearly 99 per cent experience an activity impairment. These percentages are lower among those who said their IBD is in remission.
On average, 40 per cent of patients will need to take some time off work per year, with the average absenteeism rate at about one workweek per year, said Jairath. The disease can also lead to long-term work loss, particularly for patients who experience severe bouts and need surgeries or hospitalizations and those who suffer complications related to their IBD.
Read: How benefits plans can help manage inflammatory bowel disease
But to colleagues and managers the disease is often a hidden illness, Jairath said. “One of my patients wrote a beautiful article and I have it pinned up in my office. She talked about this hidden disability that she has, that she looks completely normal but [she has] these debilitating, embarrassing symptoms . . . and [she] looks fine but how does she justify that?”
Until 2015, there were only two advanced therapies available to treat IBD — both biologics — but the treatment options have multiplied since then. Between 2022 and 2023, four new drugs were approved to treat Crohn’s and/or ulcerative colitis. The current treatments work slightly differently and target different parts of the immune system to dampen inflammation.
Biosimilar options of some treatments have started to become available. Jairath noted while biosimilars are so “highly similar” to biologics that there’s no meaningful clinical difference, medication switching can be stressful and disruptive for patients. “Ultimately, it should really be a discussion between patient and provider.”
Jairath recommended employers review their formulary to ensure employees have adequate medication choices and will be able to access the latest treatments as they’re approved. He also suggested plan sponsors ensure their physical workplaces have adequate washroom facilities that are easily accessible for employees with IBD, while providing workers with scheduling flexibility and other accommodations.
Read more coverage of the 2024 Chronic Disease at Work conference.