Inflammatory bowel disease: towards a personalized medicine

Abstract

The management of inflammatory bowel disease (IBD) has been transformed over the last two decades by the arrival of tumor necrosis factor (TNF) antagonist agents. Recently, alternative drugs have been approved, directed at leukocyte-trafficking molecules (vedolizumab) or other inflammatory cytokines (ustekinumab). New therapeutics are currently being developed in IBD and represent promising targets as they involve other mechanisms of action (JAK molecules, Smad 7 antisense oligonucleotide etc.). Beyond TNF antagonist agents, these alternative drugs are needed for early-stage treatment of patients with aggressive IBD or when the disease is resistant to conventional therapy. Personalized medicine involves the determination of patients with a high risk of progression and complications, and better characterization of patients who may respond preferentially to specific therapies. Indeed, more and more studies aim to identify factors predictive of drug response (corresponding to a specific signaling pathway) that could better manage treatment for patients with IBD. Once treatment has started, disease monitoring is essential and remote patient care could in some circumstances be an attractive option. Telemedicine improves medical adherence and quality of life, and has a positive impact on health outcomes of patients with IBD. This review discusses the current application of personalized medicine to the management of patients with IBD and the advantages and limits of telemedicine in IBD.

Fecal Calprotectin Pretreatment and Induction Infliximab Levels for Prediction of Primary Nonresponse to Infliximab Therapy in Crohn’s Disease

“…Thus, it could be sensible to attempt to detect drug concentrations at week 14 to decide subsequent doses. Along these lines, the development of a rapid test for drug levels would be convenient [1]. Whether or not the strategy of measuring levels prior to the following infusion and increasing the dose of anti-TNF drug when not reaching the cut-off could result in better remission induction rates deserves further exploration.…”

“…Ulcerative colitis (UC) and Crohn's disease (CD) are the 2 main forms of inflammatory bowel disease (IBD) [1]. Both conditions are characterized by chronic inflammation of the gastrointestinal tract, and the pathogenesis is not yet completely understood [2].…”

Oral Delivery of Biologics for Precision Medicine

“…In this scenario, personalized medicine becomes critical for the correct use of these therapies. [143] During medication, more parameters (e.g., biologic, endoscopic, and histologic) have been used to monitor the status of diseases, and the remote care of patients by telecommunications (telemedicine) has been found useful to improve the medical adherence and therapeutic outcome. Accordingly, clinical trials are becoming more personalized to reach this unmet need.…”

Review article: the genetics of the human leucocyte antigen region in inflammatory bowel disease

“…The clear direction of movement in IBD therapy is towards improved, personalised, treatment reducing the significant side effects and complications that some medications may present. 119 The future direction of HLA research in IBD has many opportunities for advancement and may include screening for risk of disease development, alongside use of HLA genotyping in models for predicting disease outcomes. Whilst challenges remain, this complex genetic region is likely to hold vital information in the future understanding of disease pathogenesis and may be key in promoting precision medicine in IBD.…”