Outcomes and Strategies to Support a Treat-to-target Approach in Inflammatory Bowel Disease: A Systematic Review
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- Jean-Frédéric Colombel
- Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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- Geert D’haens
- Amsterdam University Medical Centers – Inflammatory Bowel Disease Unit, University of Amsterdam, Amsterdam, The Netherlands
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- Wan-Ju Lee
- Global Gastroenterology, AbbVie, North Chicago, IL, USA
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- Joel Petersson
- Global Gastroenterology, AbbVie, North Chicago, IL, USA
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- Remo Panaccione
- Inflammatory Bowel Disease Clinic, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Description
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background and Aims</jats:title> <jats:p>Management of Crohn’s disease and ulcerative colitis has typically relied upon treatment intensification driven by symptoms alone. However, a ‘treat-to-target’ management approach may help to address underlying inflammation, minimise disease activity at early stages of inflammatory bowel disease, limit progression, and improve long-term outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A systematic literature review was conducted to identify data relevant to a treat-to-target approach in inflammatory bowel disease, published between January 1, 2007 and May 15, 2017.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Consistent with recommendations of the Selecting Therapeutic Targets in Inflammatory Bowel Disease [STRIDE] working group, studies have investigated factors influencing the achievement of both endoscopic and histological mucosal healing and patient-level outcomes in inflammatory bowel disease [IBD]. Histological healing and biomarker levels have also been shown to be modifiable outcomes. Although there is a lack of prospectively derived evidence validating mucosal healing as a treatment target, data are emerging to suggest that targeting mucosal healing or inflammation rather than symptoms may be cost-effective in some settings. The review highlighted several strategies that may support the implementation of a treat-to-target approach in IBD. The prospective randomised CALM study demonstrated how tight control [whereby treatment decisions are based on close monitoring of inflammatory biomarkers] leads to improvements in endoscopic and clinical outcomes. The review also considered the influence of coordinated care from a multidisciplinary team and patient engagement with improved adherence, as well as the role of therapeutic drug monitoring in inflammatory bowel disease management.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>A treat-to-target strategy may impact on disease progression and improve outcomes in inflammatory bowel disease. Prospective studies including long-term data are required to ensure that the most appropriate targets and strategies are identified.</jats:p> </jats:sec>
Journal
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- Journal of Crohn's and Colitis
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Journal of Crohn's and Colitis 14 (2), 254-266, 2019-08-12
Oxford University Press (OUP)
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Details 詳細情報について
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- CRID
- 1361981470762767232
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- ISSN
- 18764479
- 18739946
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- Data Source
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- Crossref