Personalizing Therapy for Inflammatory Bowel Diseases

Ashwin N Ananthakrishnan

Disclosures

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

In This Article

Expert Commentary

Box 1 describes the various clinical, genetic and serologic risk factors that could be incorporated into routine practice to personalize therapy in patients with IBD. While the ultimate goal would be to perform a one-stop assessment at diagnosis or early on in disease course that would enable prediction of natural history, likely therapeutic options that would benefit the patient, and options that may be associated with an unacceptably high risk of adverse events, such a scenario is not yet available and remains a goal to strive for in our quest to optimize the outcomes of patients with these complex chronic diseases. However, currently available genetic and serologic testing is expensive and not cost-effective to be routinely used in all patients. Furthermore, we also lack information that early aggressive intervention based solely on the genetic or serologic risk factors alters natural history of disease. From a practical standpoint, the presence of one or more clinical risk factors (Box 1) should at least trigger consideration for early aggressive therapy since that has been proven to have greater efficacy. Individuals with multiple risk factors for an aggressive course of their CD (e.g., ileal location and penetrating disease) should be considered strong candidates for early effective intervention, while an individualized discussion can be had with patients with only one such risk factor. There are weaker data on the need for a similar approach in ulcerative colitis where the only clinical risk factor consistently demonstrated is the presence of pancolitis. However, since such a phenotype will be seen in a substantial proportion of patients with UC, early top-down therapy cannot be recommended routinely in all those with the presence of this one risk factor. There is a need to refine prognostication tools in UC that could help stratify those with severe disease, and tailor therapy toward early aggressive intervention for such patients.

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