Personalizing Therapy for Inflammatory Bowel Diseases

Ashwin N Ananthakrishnan

Disclosures

Expert Rev Gastroenterol Hepatol. 2013;7(6):549-558. 

In This Article

Abstract and Introduction

Abstract

Inflammatory bowel diseases (IBDs; e.g., Crohn's disease [CD] and ulcerative colitis [UC]) are chronic immunologically mediated diseases characterized by frequent relapses, often requiring hospitalization and surgery. There is substantial heterogeneity in the progressive natural history of disease with cumulative accrual of bowel damage and impairment of functioning. Recent advances in therapeutics have significantly improved our ability to achieve disease remission; yet therapies remain expensive and are associated with significant side effects precluding widespread use in all patients with IBD. Consequently, algorithms for the management of patients with IBD require a personalized approach incorporating an individual's projected likely natural history, the probability of response to a specific therapeutic agent and an informed approach to management of loss of response to current therapies.

Introduction

Inflammatory bowel diseases (IBDs) affect an estimated 1.7 million Americans and 2.2 million people in Europe.[1–3] In addition, there is a rising incidence of IBD in parts of the world where they were previously considered uncommon.[4] Annual IBD-related healthcare costs in the USA are estimated to be nearly US$6 billion.[5] The burden of these illnesses is further extended by their onset during adolescence or young adulthood and protracted course characterized by relapses through much of the economically productive years. Despite significant advances in therapy that have enhanced our ability to achieve disease remission, the costs of such treatments remain considerable precluding widespread adoption. In addition, safety concerns of such therapies remain. Personalizing therapy for IBD rests on two premises. First, that we can predict which patients are likely to have aggressive disease, and second, that early therapy in such patients prevents disease progression, related complications and maintains bowel function. This review attempts to summarize the existing literature that addresses the above two questions, identify gaps in research, and suggest potential areas for exploration in future studies.

processing....