IBD prognosis must be considered to optimize therapy, expert says
BOSTON — Recognizing potential disease severity rather than exclusively focusing on current symptoms will be key in the future treatment of patients with inflammatory bowel diseases, according to a presentation given at the Interdisciplinary Autoimmune Summit.
Stephen B. Hanauer, MD, medical director of the digestive health center at Northwestern Medicine, said that the current indications for biologics in the treatment of moderate-to-severe IBD only consider a patient’s current disease activity and not their long-term disease severity and inflammatory complications.
“Our symptoms do not reflect the underlying disease burden,” Hanauer said. “All of us in GI see patients we scope who have bad disease and no symptoms, and conversely, we see people who have clear colons but a lot of symptoms.”
Hanauer said current IBD indexes, such as Crohn’s Disease Activity Index (CDAI) and Mayo score, only reveal a patient’s current state, and generally steer patients toward effective biologic therapies only after they develop moderate-to-severe disease complications like strictures and fistulas. He is currently working with a team to develop a disease severity index that considers factors gastroenterologists will see in their clinics that will help them predict disease severity, including severity of lesions, relevant biomarkers, and several other factors.
If such a new severity index can be developed, Hanauer said patients with a prognosis for severe disease can be put on more effective therapies much closer to diagnosis, helping them avoid intestinal damage and promoting better long-term outcomes. Additionally, patients diagnosed with lower disease severity can receive treatment as activity arises without more drastic therapies.
“I think we really need to consider this in the future because it’s how we want to treat our patients from the onset,” Hanauer said. “We want to pick out the patients who are going to have the more rapid progression and insert the therapy at that point. Then, the patients with the milder prognosis of long-term disease can be spared both the costs and risk of those therapies.” – by Alex Young
Hanauer SB. “Redefining ‘Disease Severity’ in IBD.” Presented at: Interdisciplinary Autoimmune Summit; April 27-29, 2018; Boston, Mass.
Disclosures: Hanauer reports that he is a consultant for AbbVie, Allergan, Amgen, BMS, Boehringer-Ingelheim, Celgene, Celltrion, Ferring, Gilead, Janssen, Lilly, Merck, Pfizer, Salix, Shire, Takeda, and UCB.