Biomarkers in Inflammatory Bowel Diseases: Predicting the Indication and the Effect of Biologics

Abstract

Crohn’s disease and ulcerative colitis, the two most common inflammatory bowel diseases (IBD), arecharacterized by chronic relapsing inflammation. Although recent progress regarding the therapeutic approachto these diseases has been made in the development of biologic therapies, not every patient responds well,resulting in a high percentage of ineffectiveness. Even though the immunological cascades range between thecurrent pharmacological agents for IBD treatment and the constant research for more possible pharmacologicaltargets, a lot of progress still needs to be made regarding the correct therapeutical choice for each individualpatient. Therefore, it is still important to find proper, inexpensive, and measurable biomarkers, in order to beable to assess the efficacy of these therapies, to make personalized choices, as well as to avoid potential adversedrug reactions and side effects. The biomarkers that are available in the present vary; metabolic, microbial,cytokine-related, genetic, disease-specific and drug-specific. This review presents the existing biological agentsfor IBD and focuses both on the cascades affected by each biologic agent and on the different markers thathave been found to be indicative of their effectiveness.

Longitudinal Measurements of Blood Biomarkers in Patients with Crohn’s Disease or Ulcerative Colitis Treated with Infliximab: Only the Latest Values in the Induction Period Predict Treatment Failure

“…In our study, there were no differences between patients with UC and CD. For CRP, this is not in accordance with several studies, which state that a high CRP response is mainly seen in patients with CD but not with UC [3]. For hemoglobin, the reverse has been reported, i.e., it is prognostic in patients with UC but not with CD [10].…”

“…The fecal calprotectin level is the gold standard for assessing the severity of IBD [3,14]. Our real-life data were too sparse to incorporate this specimen type in the prognostic assessment, as only 993 patients (34.4%) had fecal calprotectin specimens, and among these, 578 (58.2%) had one specimen only, which hampered longitudinal analyses.…”

“…This strategy assumes that it is preferable to completely exhaust one treatment option before discontinuing or changing the biologic therapy. Although tumor necrosis 2 of 13 factor (TNF)-blocking therapy has resulted in long-term remission for CD and UC, up to 35% of the patients may have primary failure to this therapy [3]. Induction therapy for infliximab consists of three infusions: at day 0 and after 2 and 6 weeks, followed by maintenance therapy every 8 weeks.…”

“…The blood biomarkers C-reactive protein (CRP), serum albumin, and hemoglobin are often used as standard biomarkers when starting and continuing biologic therapy. Among these, the inflammatory marker CRP has gained the most attention [3]. Serum albumin is a negative inflammatory biomarker [4] and a strong prognostic predictor in many diseases [5,6].…”

Emerging strategy towards mucosal healing in inflammatory bowel disease: what the future holds?

“…Some scholars have suggested that fecal calprotectin and other markers can serve as substitutes for serum or fecal markers (38)(39)(40). This approach would alleviate the discomfort experienced by IBD patients and reduce treatment costs (41). In the past few years, the application of artificial intelligence (AI) has mitigated operator errors in endoscopy or pathological interpretation and optimized diagnostic criteria for mucosal healing (42,43).…”