Evolution of Treatment Targets in Inflammatory Bowel Disease
Main Article Content
Abstract
Inflammatory Bowel Disease (IBD), which encompasses Crohn's disease and ulcerative colitis, represents a chronic and progressive condition characterised by periods of active inflammation interspersed with periods of remission. The resulting disease burden, arising from patient symptoms and complications, leads to a diminished quality of life for individuals with IBD. Despite significant advancements in the management of IBD, the ideal treatment targets are uncertain. The evolution of treatment targets in IBD signifies a paradigm shift from mere symptom control to a more holistic approach that aims at achieving deeper remission and improving patients' quality of life. The “treat-to-target” paradigm, guided by international consensus and expert insights, emphasises the importance of tailoring therapeutic goals to individual patient needs and disease severity. As our understanding of IBD's underlying mechanisms deepens and therapeutic options expand, treatment goals have evolved to include not only clinical response but also the pursuit of more objective endpoints such as endoscopic healing. Emerging targets, such as the assessment of transmural healing through cross-sectional imaging and the focus on histologic remission as a predictor of long-term outcomes, hold great promise in further refining IBD management strategies. However, further research is needed to recommend these treatment targets in clinical practice. In the review we explore the ongoing evolution of treatment targets in IBD aimed at optimising patient outcomes and ultimately improving quality of life (QoL).
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How to Cite
KYRIACOU, Maro; VUYYURU, Sudheer Kumar; MORAN, Gordon William.
Evolution of Treatment Targets in Inflammatory Bowel Disease.
Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4662>. Date accessed: 16 may 2024.
doi: https://doi.org/10.18103/mra.v11i11.4662.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Collaborators GBDIBD. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(1):17-30.
3. Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2017;390(10114):2769-2778.
4. Wang R, Li Z, Liu S, Zhang D. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019. BMJ Open. 2023;13(3):e065186.
5. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; preliminary report on a therapeutic trial. Br Med J. 1954;2(4884):375-378.
6. Vermeire S, van Assche G, Rutgeerts P. Review article: Altering the natural history of Crohn's disease--evidence for and against current therapies. Aliment Pharmacol Ther. 2007;25(1):3-12.
7. Wilson A, Choi B, Sey M, Ponich T, Beaton M, Kim RB. High infliximab trough concentrations are associated with sustained histologic remission in inflammatory bowel disease: a prospective cohort study. BMC Gastroenterol. 2021;21(1):77.
8. Gracie DJ, Williams CJ, Sood R, et al. Poor Correlation Between Clinical Disease Activity and Mucosal Inflammation, and the Role of Psychological Comorbidity, in Inflammatory Bowel Disease. Am J Gastroenterol. 2016;111(4):541-551.
9. Cellier C, Sahmoud T, Froguel E, et al. Correlations between clinical activity, endoscopic severity, and biological parameters in colonic or ileocolonic Crohn's disease. A prospective multicentre study of 121 cases. The Groupe d'Etudes Therapeutiques des Affections Inflammatoires Digestives. Gut. 1994;35(2):231-235.
10. Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021;160(5):1570-1583.
11. Cohen ER, Melmed GY. Making a Case for Patient-Reported Outcomes in Clinical Inflammatory Bowel Disease Practice. Clin Gastroenterol Hepatol. 2018;16(5):603-607.
12. Irvine EJ, Zhou Q, Thompson AK. The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn's Relapse Prevention Trial. Am J Gastroenterol. 1996;91(8):1571-1578.
13. Best WR, Becktel JM, Singleton JW, Kern F, Jr. Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976;70(3):439-444.
14. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041-1048.
15. Baars JE, Nuij VJ, Oldenburg B, Kuipers EJ, van der Woude CJ. Majority of patients with inflammatory bowel disease in clinical remission have mucosal inflammation. Inflamm Bowel Dis. 2012;18(9):1634-1640.
16. Laterza L, Piscaglia AC, Minordi LM, et al. Multiparametric Evaluation Predicts Different Mid-Term Outcomes in Crohn's Disease. Dig Dis. 2018;36(3):184-193.
17. Colombel JF, Panaccione R, Bossuyt P, et al. Effect of tight control management on Crohn's disease (CALM): a multicentre, randomised, controlled phase 3 trial. Lancet. 2017;390(10114):2779-2789.
18. White JR, Jairath V, Moran GW. Evolution of treatment targets in Crohn's disease. Best Pract Res Clin Gastroenterol. 2019;38-39:101599.
19. Schoepfer AM, Beglinger C, Straumann A, et al. Fecal calprotectin correlates more closely with the Simple Endoscopic Score for Crohn's disease (SES-CD) than CRP, blood leukocytes, and the CDAI. Am J Gastroenterol. 2010;105(1):162-169.
20. Stjernman H, Tysk C, Almer S, Strom M, Hjortswang H. Factors predicting the outcome of disease activity assessment in Crohn's disease. Inflamm Bowel Dis. 2009;15(12):1859-1866.
21. Arias MT, Vande Casteele N, Vermeire S, et al. A panel to predict long-term outcome of infliximab therapy for patients with ulcerative colitis. Clin Gastroenterol Hepatol. 2015;13(3):531-538.
22. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317(26):1625-1629.
23. Restellini S, Chao CY, Martel M, et al. Clinical Parameters Correlate With Endoscopic Activity of Ulcerative Colitis: A Systematic Review. Clin Gastroenterol Hepatol. 2019;17(7):1265-1275 e1268.
24. Rochelle TL, Fidler H. The importance of illness perceptions, quality of life and psychological status in patients with ulcerative colitis and Crohn's disease. J Health Psychol. 2013;18(7):972-983.
25. Khanna R, Wilson AS, Gregor JC, Prowse KL, Afif W. Clinical Guidelines for the Management of IBD. Gastroenterology. 2021;161(6):2059-2062.
26. Le Berre C, Ricciuto A, Peyrin-Biroulet L, Turner D. Evolving Short- and Long-Term Goals of Management of Inflammatory Bowel Diseases: Getting It Right, Making It Last. Gastroenterology. 2022;162(5):1424-1438.
27. Colombel JF, Rutgeerts PJ, Sandborn WJ, et al. Adalimumab induces deep remission in patients with Crohn's disease. Clin Gastroenterol Hepatol. 2014;12(3):414-422 e415.
28. Colombel JF, Rutgeerts P, Reinisch W, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011;141(4):1194-1201.
29. Mary JY, Modigliani R. Development and validation of an endoscopic index of the severity for Crohn's disease: a prospective multicentre study. Groupe d'Etudes Therapeutiques des Affections Inflammatoires du Tube Digestif (GETAID). Gut. 1989;30(7):983-989.
30. Koutroumpakis E, Katsanos KH. Implementation of the simple endoscopic activity score in crohn's disease. Saudi J Gastroenterol. 2016;22(3):183-191.
31. Daperno M, D'Haens G, Van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD. Gastrointest Endosc. 2004;60(4):505-512.
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