Personalised therapy for inflammatory bowel disease

Children presenting with inflammatory bowel disease (IBD) typically have a moderate-to-severe disease phenotype, accompanied by frequent complications and challenging management. 1 Oliveira SB Monteiro IM Diagnosis and management of inflammatory bowel disease in children. BMJ. 2017; 357: j2083 Google Scholar However, substantial differences exist between patients, with some having relatively quiescent disease and others requiring early escalation of therapy or early surgery. 2 Hyams JS Davis P Grancher K Lerer T Justinich CJ Markowitz J Clinical outcome of ulcerative colitis in children. J Pediatr. 1996; 129: 81-88 Google Scholar Robust predictors of disease outcome have the potential to affect disease management, but generation of such predictors is only possible if data are collected rigorously and analysed carefully—a challenge for researchers outside of clinical trials. This question is particularly important in paediatric IBD because nutrition and growth are important outcomes, there is potential for toxic side-effects from treatment, and a high incidence of surgical resection has been seen in historical cohorts. 2 Hyams JS Davis P Grancher K Lerer T Justinich CJ Markowitz J Clinical outcome of ulcerative colitis in children. J Pediatr. 1996; 129: 81-88 Google Scholar In the past few years, management of adult-onset IBD has shifted to a top-down treatment strategy, and simultaneously a so-called treat-to-target approach is being increasingly considered in children. 3 Bouguen G Levesque BG Feagan BG et al. Treat to target: a proposed new paradigm for the management of Crohn's disease. Clin Gastroenterol Hepatol. 2015; 13: 1042-1050 Google Scholar However, concern exists that one size does not fit all, with substantial variation in response to therapy, treatment toxicity, requirement for escalation, and long-term outcomes, presumably reflecting multiple different disease subtypes. 4 Roda G Jharap B Neeraj N Colombel JF Loss of response to anti-TNFs: definition, epidemiology, and management. Clin Transl Gastroenterol. 2016; 7: e135 Google Scholar , 5 Hyams JS Lerer T Griffiths A et al. Long-term outcome of maintenance infliximab therapy in children with Crohn's disease. Inflamm Bowel Dis. 2009; 15: 816-822 Google Scholar Clinical and biological predictors of response to standardised paediatric colitis therapy (PROTECT): a multicentre inception cohort studyOur findings support the utility of initial clinical activity and treatment response by 4 weeks to predict week 52 corticosteroid-free remission with mesalazine alone in children who are newly diagnosed with ulcerative colitis. The development of personalised clinical and biological signatures holds the promise of informing ulcerative colitis therapeutic decisions. Full-Text PDF