Biological Therapies in Inflammatory Bowel Disease: Top-down or Bottom-up?

Bas Oldenburg; Daan Hommes

Disclosures

Curr Opin Gastroenterol. 2007;23(4):395-399. 

In This Article

Goals of Therapy

The goal of therapy in IBD is to induce and maintain remission in order to realize the best attainable quality of life. In ulcerative colitis, assessment of disease activity and remission is relatively straightforward. Disease activity is nearly always associated with the presence of diarrhoea or bloody stools and can be easily confirmed by sigmoidoscopy. In Crohn's disease, assessment of remission is more complex, due to the heterogeneity of the disease. In clinical practice, most physicians rely on the absence of complaints, although these poorly correlate with biochemical parameters or endoscopic activity. In clinical trials, remission is generally defined using the Crohn's Disease Activity Index (CDAI), a score of less than 150 signifying remission. Since the CDAI relies heavily on symptomatic parameters, it does not come as a surprise that its correlation with endoscopic scores or histological activity is weak.[22] Presently, an unambiguous clinical and endoscopic definition of remission in Crohn's disease is lacking, hampering the efforts of clinicians to formulate clear therapeutic objectives for the long term.

A growing body of evidence shows that infliximab induces mucosal healing and that this phenomenon is associated with a reduction of hospitalizations and surgical procedures.[23,24] Although it is not clear whether this translates into improved long-term clinical responses, it may be assumed that adjusting the medical therapy to the presence or absence of mucosal ulceration modifies the natural history of Crohn's disease.

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