Treat‐to‐target and sequencing therapies in Crohn's disease

Abstract

Crohn's disease (CD) is a chronic immune‐mediated inflammatory condition which can negatively impact a patient's quality of life. The traditional management strategy for CD has focused on symptomatic control, however, this approach fails to prevent organ damage and to change the progressive course of this disease. Thus, the field has moved towards a treat‐to‐target strategy that includes identifying individualized objective targets, choosing a therapy based on individual factors that include disease severity and risk, closely monitoring disease activity at predefined time points, and optimizing therapies as needed. Due to the increasing number of therapies approved for CD, this review explores the various factors which should be considered in the sequencing of treatment options together with using the treat‐to‐target framework to control disease activity early in its course and provide holistic patient care.

Measuring what matters: Why and how to include patient reported outcomes in clinical care and research on inborn errors of metabolism

“…It can be applied to PROMs as well as to biochemical or physical parameters and is based on identification and definition of a core set of appropriate treatment targets under consideration of the available evidence and defined in a shared decision process involving experts, patients, and caregivers. Interventions are tested regarding their performance to reach these pre‐defined targets 62 …”

“…For conditions that are extremely heterogeneous and/or progressive, the treat‐to‐target approach that is closely related to the concepts of MIC responders and goal attainment scales may be especially useful 4 . The treat‐to‐target approach has been successfully implemented in diabetes, 61 Crohn's disease, 62 and paediatric rheumatology 59 care and research. It can be applied to PROMs as well as to biochemical or physical parameters and is based on identification and definition of a core set of appropriate treatment targets under consideration of the available evidence and defined in a shared decision process involving experts, patients, and caregivers.…”

Changing paradigms in management of inflammatory bowel disease

“…A review by Garcia et al. 16 focused on the activity and severity of the disease, comorbid illnesses, disease phase, and accessibility and affordability. To provide a landscape of new drugs in IBD, Vieujean et al.…”

“…With the emergence of new treatment options, a variety of factors shall be considered while selecting the most adequate therapeutic approach. A review by Garcia et al 16 focused on the activity and severity of the disease, comorbid illnesses, disease phase, and accessibility and affordability. To provide a landscape of new drugs in IBD, Vieujean et al conducted an exhaustive search using Clin-icalTrials.gov.…”

Perianal fistulizing Crohn's disease and overall risk of cancer: No red flag

“…Perianal fistulizing disease affects 20%–30% of patients with Crohn's disease (CD) 2 and has been associated with an increased risk of anal cancer 3 . Despite advances in the therapeutic management, the risk of poor disease course remains substantial 4 . Chronic perianal inflammation plays a key role in carcinogenesis and due to their location, cancers in this setting are rarely diagnosed at an early stage 5 .…”