Y-ECCO Interview Corner: Laurent Peyrin-Biroulet

 

Laurent Peyrin-Biroulet © ECCO

What has the period of being President-Elect been like?

First of all, when I was elected 2 years ago I already had a significant role. As President-Elect you are already involved in Governing Board activities and in all the big decisions for ECCO: this is a way of being trained before taking this position. I would say one thing that is very important – when we make a decision with the Governing Board it is the majority that decides, not only the President. It is also good during the transition to be exposed to everything so that when you become President you are prepared for what is going on. The number of activities at ECCO is huge, but before this role I was Secretary, so I was more prepared for that.

What is your presidential vision for ECCO?

My aim is that when people plan their year and decide they want to go to an IBD Meeting they choose this IBD meeting – they choose ECCO.

Why should they choose this?

Well, the atmosphere is unique and that’s very important, so we should keep a friendly atmosphere. The ECCO Interaction: Hearts and Minds is part of it, but I think we need to have as many social activities as we can, even though the number of attendees is now very big – so this is a challenge. I believe that keeping the format, which has been very successful, is important; there should not be too many parallel sessions, even though we are now obliged to have a little bit of basic science in the parallel sessions. The biggest challenge for me will be the balance between academia and industry because even if people like to see the results of the phase 2 and phase 3 trials – we always have full audiences for that – I think that the academic research should still be our priority. Now we have new molecules and new treatments and the IBD Pipeline is totally crazy, but even so, the science should not be too industry driven. We may even need to consider a cap on industry presentations, because the number of slots for presentations, even with the digital oral presentations, is still very limited. On the other hand, I still believe that running science by itself is perhaps not the main goal of ECCO. I think that facilitating science by providing the network is very good, but leading clinical science and research projects is probably not the goal. The education that ECCO provides is fantastic. Quite a lot of education is provided by industry but the education from ECCO is independent and it makes a nice balance between industry and academia. I am not aware of another organisation that can deliver this education. We also need to have creativity: we should keep what works but always adapting it a little bit with new things. We need to think about format – social networking, online education and podcasts – to keep ECCO modern.

Where does Y-ECCO fit into this?

Once you get into IBD, you know that it will probably be the rest of your career, so it is good to build strong links in the beginning – we have to work together and we have to know each other. I “grew up” with Silvio, and we are the same age (although he says he is much younger, he is actually only 6 months younger!), but I still work together with Silvio today as well as with many other friends. Doing research and education alone will not move the field forward: you need to collaborate. Y-ECCOs also need to get to know the ECCO Spirit!

How did it end up being IBD?

To be honest, in the beginning I wanted to be a cardiologist. However, in France there is a national ranking and I got gastroenterology. But then I got my fellowship and it was just when infliximab came onto the market and I could see that I could change patients’ lives – you could change everything for them. It was like a magic bullet and I was very impressed when I saw a patient telling the head of my department that the treatment had changed their life. Also we have IBD in my family.  I am very close to my cousin, who has had very severe Crohn’s Disease since he was 5 years old, and all these things really motivated me in IBD. I also had an opportunity – my centre was focussed on care but did not have a research and education section. We had a very big cohort; we were the only IBD centre between Paris, Germany and South-eastern France and we had this big cohort with tons of patients, so there was a big opportunity. I wanted to build something. It is good to be in a big IBD centre and “grow up “ in the best centre in the world, but then everything is already there and I think it is better to build something. So I had to start from scratch.

You went to the United States. How did that influence you?

Yes, I did 2 years with Jean-Fred Colombel and then one year at the Mayo Clinic with Bill Sandborn and Ed Loftus. This was fantastic because for the first time in my career I had more freedom for time with my family and I had a lot of research time. It was a new world; I have always been fascinated by the United States. My parents did not have the possibility to travel but they always talked to me about the American dream. Now going to the United States is nothing, but for my parents’ generation it was a really big thing. The Mayo Clinic is unique because it is so well organised.

Back in France you became involved in the GETAID research network, which has been very successful and produced high-quality research on what appears to be a very low budget. What has made GETAID so successful?

Everybody can send in a proposal. Everybody can be PI and everybody will help everybody because we are looking at questions that industry is not interested in. We also believe that if you do something for a clinical trial you should always be part of the author list. We have small centres involved, so they get rewarded, and I am always impressed when, at our general assembly, we discuss the study protocol and everybody gets very excited because everyone wants to improve it. Historically we generated these studies at almost no cost, but to meet the current clinical governance standards we have had to hire almost ten people.

It is important in GETAID that young people can take the lead – this happens more and more. Even the young investigators can be first author. I don’t think it makes sense to be the professor and to be first author. We have small centres, medium-sized centres and large centres all contributing patients. There is always a lot of excitement when we present the results. Now it is also over all of France, whereas before GETAID was more centred on Paris. It can be hard to explain why your recipe is working, but I think a key point at the end is that the network is open and everyone who is working on the project is rewarded.

With all of these different activities, do you get to see any patients?

Yes, in fact I still have approximately 1000 outpatient visits per year. When I have the clinic it is a very busy day. But I think this is important. There is no sense and no goal unless everything you do and achieve can be translated into your practice. When you become more successful at the international level you risk two things: patients and national level involvement. So I try to maintain those. We are well organised in our clinic: we have a great team, which means I can be very efficient at work. We have a secretary taking care of the dates and we have an IBD nurse taking care of the outline. All the help from the IBD Nurses means I can be very efficient, but it took me 10 years to get this organisation in place.

What is your pet project at the moment?

I have learnt that a big project takes a decade. We have the I-Care project, which will show results soon. To put it simply, what the CESAME study was for azathioprine, I-Care is for biologics. Now we have optimised the protocol and capitalised on the experience from CESAME. Everything that we failed with or were frustrated by in CESAME we have been able to do better with I-Care. But we started in 2010 and the first results will come in 2022, so that is a 12-year project. It is pan-European so I like it very much. In other projects I have tried to bring new concepts. Sometimes this has drawn the criticism that there is no evidence to support a new idea. Some years ago I started thinking about early Crohn’s Disease, and we organised the CURE trial within GETAID. In that study we treat IBD patients very early with anti-TNF; when they have attained deep remission we stop and then we monitor and then we re-start if necessary. The outcomes will be fantastic to know – I still believe that combination treatment with thiopurines and infliximab is the best treatment, but it is difficult to continue it for 50 years.  The CURE study also started 10 years ago, so the young have to be in it for the long run.

What do you do when you’re not working?

Well, I am working on that! Right now I am travelling less at the weekends and trying to spend my weekends with my family. I played football for many years and at one time I was hesitating between medicine and my dream of being a sports teacher. I used to do sports every day, and I miss the sport. But I feel guilty if I am at home to then take time away from the family to go and, for example, play football. So in the end when I am at home I spend my time with my wife and taking care of my kids .

So basically what you do is work, spend time with your kids and spend time wishing you could play football?

Yes, that’s a good summary!

How do you handle the stress of all these different roles?

The only stress is really when you have deadlines. I was almost the first in my family to finish high school and for sure the first to be a physician, so for me I just think I am so fortunate to be doing the jobs I do, even though it is very busy.  So I have no stress at all, I just enjoy it. We are a small piece in the world and what one person does is not changing the whole world.  Even though we are here at ECCO and we all want to help patients and we are IBD people so we think this is everything - but it is actually a very small part of the world.

What is your advice for Y-ECCOs who are hoping for a career in IBD?

So my advice is not to think about your career! Whatever people think, I have no ambition at all. I have only two things that are important. One is that I like challenges. The other is that when you have finished something to let it go from your mind. I try to never look back – what is important is the next challenge. No ambition, just keeping the passion for what you do.

Charlotte Hedin, Y-ECCO Member

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