Are We Ready to Change the Course of Inflammatory Bowel Disease?

Abstract

The objectives of the symposium were to raise awareness of the importance of treating early, setting treatment goals, and using enhanced clinical monitoring in inflammatory bowel disease (IBD). The progressive nature of Crohn’s disease (CD) leading to bowel damage is well-established, but, according to Prof Peyrin-Biroulet, there may be a window of opportunity early in the disease when progression can be prevented through early diagnosis coupled with early intervention. The same approach should be adopted for the treatment of ulcerative colitis (UC), which he noted is frequently undertreated. UC is also progressive and the overall disability associated with UC is similar to CD. Prof Colombel described the treat to target (T2T), with tight control (TC), approach in IBD. The target is a composite endpoint of clinical and endoscopic remission, determined and agreed upon with the patient. In this approach, the disease is continuously monitored and treatment modified until the target is reached with the primary aim of blocking disease progression. The CALM study1 demonstrated that a significantly higher proportion of patients in the TC arm achieved mucosal healing at 1 year compared to patients with a conventional treatment management. In order to illustrate the benefits of early diagnosis, Prof Panaccione presented two cases from clinical practice who exhibited similar symptoms at disease onset. The first case took 3 years to present; her treatment was managed conventionally and escalated according to symptoms with no assessment of biomarkers. She had recurrent symptoms and eventually required ileocaecal resection. By contrast, in the second case, diagnosis occurred within 4 months of symptom onset, and biomarkers were assessed. Biological treatment was initiated at the second consultation and optimised with a TC approach. The treatments in both cases were similar; however, conventional management resulted in disease progression and the T2T approach with TC resulted in asymptomatic, full disease control. Prof Louis emphasised that good communication between physicians and patients results in the development of goals that are both relevant and meaningful to patients. Patient-reported outcomes (PRO) are increasingly included in clinical trials and required by regulatory agencies. Prof Louis described how tools such as the IBD Disk, which was developed in partnership with patients, can highlight issues that impact the patient’s life and therefore aid in optimal communication between physicians and patients.