To the editor,
We appreciate the opportunity to respond to the letter commenting on our recently published commentary “Inflammatory Bowel Diseases in Egypt During the COVID-19 Pandemic.” The letter raised 4 important points to be clarified:
Including the mentioned biologic drugs in our commentary does not mean that we only use these agents; we, as inflammatory bowel disease (IBD) consultants, have extended experience in managing and treating many patients with IBD referred from all over Egypt to our unit in the past 10 years, especially with the rising reputation of our specialized unit with its multidisciplinary approach and updated management among doctors of similar specialties who have presented their work in various scientific meetings, conferences, and international publications.
Our unit’s strategy in treatment and choice of biologics: we definitely follow the international guidelines of the step-up approach. Regarding biologics, we provide them for free to all our patients under governmental financial insurance coverage, which allows the use of both infliximab and adalimumab. Ustekinumab will be provided shortly to our patients with IBD with the help of our hospital authorities. Initially, we reserved the use of this expensive biologic for patients resistant to other anti-tumor necrosis factor agents. Therefore, we must strongly clarify that our unit does not have any financial conflicts with any of the manufacturers that could allow the extended use of expensive biologics, in contrast to many private centers in Egypt. However, we have adequate experience in the use of ustekinumab, vedolizumab, and tofacitinib in our private centers and provide adequate choice counseling with our patients.
Our IBD unit is a tertiary referral center for patients with IBD from all over Egypt; it is not a private center or clinic. It also offers all services for patients with IBD for free and without any financial disclosures. Moreover, the unit consists of an administrative and regulatory structure including our professors in the tropical medicine department, lecturers, assistant lecturers, and residents. Our rising experience in managing Egyptian patients with IBD will be highlighted in many future publications.
The biggest challenge facing our IBD unit has been to provide biologic therapy for free to our patients who were not responding to usual treatment. We started to communicate with health insurance leaders in Egypt in 2012, presenting our protocol of IBD management and discussing the difficulties of patients with IBD in our unit. In 2013, these steps were crowned with success when infliximab was introduced to our IBD unit for the first time, making it one of the first university hospitals in Egypt to provide this biologic treatment for patients with IBD free of charge and without any financial disclosures.