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Role of biological therapy for inflammatory bowel disease in developing countries
  1. Gerhard Rogler1,
  2. Charles N Bernstein2,
  3. Ajit Sood3,
  4. Khean Lee Goh4,
  5. Jesús K Yamamoto-Furusho5,
  6. Zaigham Abbas6,
  7. Michael Fried1,7
  1. 1Division of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
  2. 2University of Manitoba IBD Clinical and Research Centre, Department of Internal Medicine, Winnipeg, Manitoba, Canada
  3. 3Department of Medicine, Dayanand Medical College & Hospital, Ludhiana, India
  4. 4Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  5. 5IBD Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
  6. 6Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
  7. 7Member of the Executive Committee, World Gastroenterology Organisation
  1. Correspondence to Professor Gerhard Rogler, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University-Hospital of Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland; gerhard.rogler{at}


Inflammatory bowel disease (IBD) has become a global disease. Its incidence in developing countries is rising. In Asia, this has been attributed to the rapid modernisation and westernisation of the population. As IBD emerges in developing nations, there is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost. In the West, biological agents are the fastest-growing segment of the prescription drug market. They typically cost several thousand to several tens of thousands of dollars per patient per year. The healthcare systems in developing countries will struggle to afford such expensive treatments. Developing countries cover two-thirds of the earth's surface and are home to 3–5 billion inhabitants, constituting three-quarters of all humanity. If IBD emerges to the same extent in those countries as it has in the West, the need for biological therapy will increase dramatically, and the pharmaceutical industry, healthcare providers, patient advocate groups, governments and non-governmental organisations will have to discuss how to handle this. The authors propose that this dialogue should begin now with regard to (1) the major needs of patients with complicated IBD in developing countries, (2) the potential need for biological therapy in developing countries to treat IBD, (3) the necessary infrastructure for selecting patients with IBD who need biological therapy, and (4) medical/ethical issues limiting the use of biological therapy.

  • Inflammatory bowel disease
  • biologics
  • developing countries
  • drug efficacy
  • macrophages
  • IBD
  • myofibroblasts
  • basic sciences
  • cell migration
  • epidemiology
  • dysplasia
  • IBD clinical
  • osteoporosis
  • ulcerative colitis
  • IBD—genetics
  • Crohn's disease
  • IBD basic research
  • gastroduodenal motility
  • gastroesophageal reflux disease
  • gastrointestinal motility
  • gastrointestinal peptides

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  • Funding MF discloses support by Astra Zeneca, Abbott, Merck, Nestle, Novartis, UCB. GR discloses grant support from Abbot, Ardeypharm, Essex, FALK, Flamentera, Novartis, Tillots, UCB and Zeller. CB has consulted for Abbot Canada, Astra Zeneca Canada and Janssen Canada, has received speaker's honoraria from Abbott Canada, Axcan Pharma and Shire Canada, has received an educational grant from Axcan Pharma, and has received a research grant from Abbott Canada.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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