title: The challenges of stratifying patients for trials in inflammatory bowel disease.
abstract: Immunotherapy with biological agents or small molecules is revolutionising the treatment of chronic inflammatory disease in humans; however, a significant proportion of patients fail to respond or lose responsiveness. This is particularly evident in inflammatory bowel disease (IBD), a group of chronic, immune-mediated disorders of the gastrointestinal tract. Different responsiveness to treatment in IBD can be explained by substantial disease heterogeneity, which is being increasingly recognised by genetic and immunological studies. The current enthusiasm for stratified medicine suggests that it may become possible to identify clinical, immunological, biochemical or genetic biomarkers to target immunotherapy to patients more likely to respond. Here, we identify and highlight the opportunities and the challenges of this strategy in the context of IBD.
authors.affiliation: Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Biancheri
authors.forename: Nick
authors.initials: N
authors.lastname: Powell
authors.forename: Giovanni
authors.initials: G
authors.lastname: Monteleone
authors.forename: Graham
authors.initials: G
authors.lastname: Lord
authors.forename: Thomas T
authors.initials: TT
authors.lastname: MacDonald
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D015212:Inflammatory Bowel Diseases / Q000276:immunology* / Q000378:metabolism / Q000628:therapy*
chemical_list: D015415:Biomarkers
keywords: biological therapy; biomarker; disease heterogeneity; tumor necrosis factor-α