Changing treatment paradigms for the management of inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) is a chronic and progressive inf lammatory condition of the gastrointestinal tract causing bowel damage, hospitalizations, surgeries, and disability. Although there has been much progress in the management of IBD with established and evolving therapies, most current approaches have failed to change the natural course. Therefore, the treatment approach and follow-up of patients with IBD have undergone a significant change. Usage of immunosuppressants and/or biologics early during the course of the disease, known as top-down or accelerated step-up approach, was shown to be superior to conventional management in patients who had been recently diagnosed with IBD. This approach can be applied to selected groups based on prognostic factors to control disease activity and prevent progressive disease. Therapeutic targets have been shifted from clinical remission mainly based on symptoms to objective parameters such as endoscopic healing due to the discrepancies observed between symptoms, objectively evaluated inf lammatory activity, and intestinal damage. The concept of treat-to-target in IBD has been supported by population-based cohort studies, post hoc analysis of clinical trials, and meta-analysis, but more evidence is needed to support this concept to be applied to the clinical practice. In addition, individualized approach with tight monitoring of non-invasive biomarker such as C-reactive protein and fecal calprotectin and drug concentration has shown to improve clinical and endoscopic outcomes. An appropriate de-escalation strategy is considered based on patient demographics, disease features, current disease status, and patients’ preferences.

The Future of Biosimilars: Maximizing Benefits Across Immune-Mediated Inflammatory Diseases

“…IBD treatment aims to change the natural history of the disease, thereby avoiding tissue damage and disability [85]. This requires prompt, early treatment and implementation of a treat-to-target approach (top-down or accelerated step-up) to achieve objective endpoints such as endoscopic remission [86][87][88][89][90][91]. Consequently, treatment paradigms are changing to introduce biologics and/or immunomodulators at an earlier stage of disease [87,90,[92][93][94][95].…”

“…This requires prompt, early treatment and implementation of a treat-to-target approach (top-down or accelerated step-up) to achieve objective endpoints such as endoscopic remission [86][87][88][89][90][91]. Consequently, treatment paradigms are changing to introduce biologics and/or immunomodulators at an earlier stage of disease [87,90,[92][93][94][95]. Numerous guidelines address the role of biologics in IBD treatment [96][97][98][99][100][101][102], generally recommending biologics as a treatment option for steroid-refractory/dependent disease or in patients who are intolerant of, or have contraindications to, conventional therapy.…”

NCoR1 Protects Mice From Dextran Sodium Sulfate–Induced Colitis by Guarding Colonic Crypt Cells From Luminal Insult

“…9,10 After the applications of genetically modified animal models and highthroughput sequencing, many key factors that are crucial in UC initiation and progression have been gradually identified and characterized. Emerging therapeutic targets provide opportunities to implement precision medicine designed to improve specific disease outcomes, such as mucosal healing, 11,12 which has been confirmed to be associated with improved long-term outcome of UC treatment. 13,14 Colonic stem cells, similar to other intestinal stem cells, reside at the bottom of the crypt base and are responsible for continuous mucosal regeneration to maintain normal intestinal homeostasis and to repair the mucosal layer after injury.…”

Trends in Healthcare Costs for Inflammatory Bowel Disease in South Korea

“…5,6 Biologic therapy with anti-TNF agents such as infliximab and adalimumab has revolutionized the treatment of IBD for their remarkable efficacy. 7 For many years, these anti-TNF agents have become the mainstay of treatment for moderately or severely active IBD patients refractory or intolerant to conventional therapy. 7,8 However, new biological and chemical drugs with different mechanisms of action from TNF blockade have been developed as potential therapeutic options for IBD, and have recently been emerging on the market.…”

“…7 For many years, these anti-TNF agents have become the mainstay of treatment for moderately or severely active IBD patients refractory or intolerant to conventional therapy. 7,8 However, new biological and chemical drugs with different mechanisms of action from TNF blockade have been developed as potential therapeutic options for IBD, and have recently been emerging on the market. 9,10 In addition to anti-TNF agents including infliximab, adalimumab, and golimumab, new drugs have recently been approved for the treatment of IBD in South Korea.…”