How to guide therapeutic decisions in a patient-tailored approach to treatment of IBD?
Therapeutic decisions in the treatment of IBD involve the initial choice of therapy(ies) and designing a long-term strategy for the individual patient. Putting forward clear therapeutic aims is therefore critical in order to assess treatment success and to guide the sequential use of therapies. Although the ultimate goal of therapy is to achieve steroid-free remission and avoid complications and surgeries, the first therapeutic intervention will achieve these aims only in a minority of patients. Depending on the requirements and successes of each stage of therapy, interim goals are pursued which may be small steps towards the total control of the disease. A patient-tailored approach does not necessarily conflict with algorithm-based decision-making; indeed, they are complementary. The former allows the skipping of some steps in the algorithm, based on the individual patient characteristics. The latter supplies a basis for the rational sequential use of drugs. Many physicians use an accelerated step-up approach in the treatment of IBD, although it has not yet been established whether this is associated with a better outcome. Whether or not an endoscopic or (and) CT or MRI assessment is conducted, the therapeutic approach should be based on mucosal activity and the location and extent of the disease. Treatments that do not heal (or at least improve) ulcers are not to be continued if they have been given a reasonable time to work. Biomarkers like C-reactive protein and calprotectin can be useful surrogates in this setting.
University of Leuven, Leuven, Belgium. paul.rutgeerts@uz.kuleuven.ac.be
Paul
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Rutgeerts
D000818:Animals; D020000:Decision Support Systems, Clinical; D004724:Endoscopy; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery / Q000628:therapy*; D017410:Practice Guidelines as Topic; D057285:Precision Medicine / Q000379:methods*; D018570:Risk Assessment