Keep CALM and Use Biomarkers in Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) has a dramatic impact on patients and their families, as well as on society as a whole due to its significant economic impact around the world.1 Achieving the best outcomes for patients relies on early intervention, a treat-to-target (T2T) approach guided by a tight control (TC) strategy, and open dialogue with the patient allowing for individualisation of treatment.2 Dr Halfvarson discussed the current understanding of C-reactive protein (CRP) and faecal calprotectin (FC), both of which are useful biomarkers for the diagnosis, monitoring, adaptation of treatment, and prediction of relapse for IBD. Dr Bossuyt outlined that monitoring based on objective markers is very important in IBD because they can detect smouldering disease activity and also correlate with background inflammation.3,4 Dr Bossuyt also discussed new data emerging from the CALM study in Crohn’s disease (CD), concluding that using biomarkers as a TC strategy can be successful in IBD management because they reflect endoscopic outcomes independent of disease location and are the main drivers of treatment decisions during monitoring.5,6 Lastly, Prof Panaccione discussed the positive impact of the T2T approach on patient quality of life (QoL) and societal costs. In the CALM study, TC resulted in improved clinical outcomes, reduced CD-related hospitalisation, and improved QoL of patients.7–10 Furthermore, an extrapolated cost-effectiveness analysis of the CALM data over 2 years, taking into account indirect costs associated with improved work productivity, found that TC reduced overall societal costs and improved patient outcomes compared to clinical management (CM).11