Lieven Pouillon

Considerations, challenges and future of anti-TNF therapy in treating inflammatory bowel disease

ABSTRACT Introduction: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic disabling conditions. Monoclonal antibody therapy directed against tumor necrosis factor-alpha (anti-TNF) has revolutionized the care of patients with inflammatory bowel disease (IBD). Areas covered: Considerations before starting anti-TNF therapy are highlighted: the best time to start with anti-TNF therapy, either alone or in combination with an immunomodulator, the choice of an anti-TNF agent and the contra-indications to anti-TNF therapy. Primary nonresponse and secondary loss of response are discussed. De-escalating therapy, the role of therapeutic drug monitoring and the use of biosimilars, are handled. Finally, the future directions of anti-TNF therapy are emphasized. Expert opinion: Anti-TNF therapy remains the cornerstone in the treatment of IBD. When initiating long-term therapy, safety and cost issues are of great importance. The therapeutic armamentarium in the treatment of IBD is rapidly growing. Therefore, the challenge is to optimize the use and refine the exact position of anti-TNF therapy in the near future, with personalized medicine as the ultimate goal.

Management of patients with inflammatory bowel disease and spondyloarthritis

ABSTRACT Introduction: More than half of the patients with inflammatory bowel disease (IBD) experience at least one extra-intestinal manifestation (EIM). The most common EIM in patients with IBD is spondyloarthritis (SpA). Microscopic intestinal inflammation is documented in almost 50% of the patients with SpA. Areas covered: We give an overview of the classification, the epidemiology and the diagnosis of IBD and SpA. The treatment goals, the pharmacologic management options and the available treatment guidelines in IBD patients with SpA are discussed. Expert commentary: The coexistence of IBD and SpA generates challenges and opportunities for both the gastroenterologist and the rheumatologist. The potential of drugs with a gut-specific mode of action in the treatment of IBD-related arthritis warrants further exploration.

Primetime for e-health in IBD?

The treatment of IBD is currently suboptimal. Continuous monitoring of patients with IBD, patient engagement and early treatment adjustments are still difficult hurdles. E-Health could be an efficient tool to improve these aspects, but the current evidence for its use in IBD is poor. An integrated cost-effective e-health system supported by a stable legal framework is eagerly needed.

Early changes in the pharmacokinetic profile of vedolizumab-treated patients with IBD may predict response after dose optimisation

We read with interest the recent paper by Colombel et al 1 showing that vedolizumab is frequently used for patients with inflammatory bowel disease (IBD). There is evidence for an exposure–efficacy relationship for vedolizumab induction therapy.2 Increasing dosing frequency of vedolizumab to every 4 weeks leads to an improvement in clinical response in both ulcerative colitis (UC)3 and Crohn’s disease (CD).4 In contrast to anti-tumour necrosis factor (TNF) agents, the correlation between the response to dose optimisation and changes in the pharmacokinetic profile of vedolizumab-treated patients remains unknown. We performed a retrospective analysis of all vedolizumab-treated …

Tofacitinib Is the Right OCTAVE for Ulcerative Colitis

Marcia Cruz-Correa, Section Editor David Schwartz, Section Editor 65 66 STAFF OF CONTRIBUTORS 67 68 69 70 71 72 73 74 75 Joseph Anderson, White River Junction, VT Johanna L. Chan, Houston, TX Matthew A. Ciorba, St. Louis, MO Massimo Colombo, Milan, Italy Gregory A. Cote, Charleston, SC Evan S. Dellon, Chapel Hill, NC Alex Ford, Leeds, United Kingdom Lauren B. Gerson, San Francisco, CA David S. Goldberg, Philadelphia, PA Samir Gupta, San Diego, CA

Mucosal Healing and Long-term Outcomes of Patients With Inflammatory Bowel Diseases Receiving Clinic-Based vs Trough Concentration-Based Dosing of Infliximab

BACKGROUND & AIMS The Trough Concentration Adapted Infliximab Treatment (TAXIT) trial demonstrated that maintaining infliximab trough concentrations at 3 to 7 &mgr;g/mL is most effective at inducing remission in patients with inflammatory bowel diseases (IBDs), with fewer flares than clinic‐based dosing. We performed a follow‐up analysis of study participants to explore the correlation between trough dosing strategy and mucosal healing, continued infliximab use, and rates of hospitalization, surgery, and steroid use. METHODS This was a retrospective single‐center study of 226 patients with IBD who completed the maintenance phase of TAXIT, performed at the University Hospitals of Leuven in Belgium. Baseline patient characteristics, laboratory test results, and endoscopic data were obtained at the end of that study between June 2012 and December 2013 (n = 125). Long‐term outcome data (IBD‐related hospitalization, abdominal surgery, and systemic steroid use) were collected from the time of the last TAXIT study visit (August 2012–April 2013) until April 1, 2016. We also collected data on continued use of infliximab and trough concentrations. RESULTS At baseline, 91% of patients in the clinic‐based dosing group and 90% of patients in the trough concentration‐based dosing group had mucosal healing. After a median follow‐up time of 41 months (interquartile range, 39–42 mo), infliximab treatment was continued by 81 of 108 patients (75%) from the clinic‐based dosing group and 86 of 107 (80%) from the trough concentration‐based dosing group. However, within 1 year, infliximab was discontinued by 10 of 27 patients (37%) from the clinic‐based dosing group and 2 of 21 patients (10%) from the trough concentration‐based dosing group (P = .04). The rates of hospitalization, surgery, and steroid use were below 15% in both groups. CONCLUSIONS At the end of a trial of clinic‐based dosing vs trough concentration‐based dosing of infliximab in patients with IBD, most patients had mucosal healing. Most patients (≥75%) in both groups continued taking infliximab for more than 3 years after the trial, but a significantly higher proportion of patients in the clinic‐based dosing group discontinued infliximab in the first year after the end of the trial. Both groups had low rates of hospitalization, surgery, and steroid use.

E-health in inflammatory bowel diseases: More challenges than opportunities?

Patients with inflammatory bowel disease need close monitoring for an optimal disease management. For this, e-health technologies are promising tools. But the current evidence for the implementation of e-health in inflammatory bowel disease is weak. For this a critical evaluation of the existing evidence is presented. Furthermore some essential conditions need to be full-filled. We need a robust digital infrastructure that is workable for the patient and the healthcare provider. Important legal issues need to be solved to protect the patient. And the e-health technologies will have to proof their durability, feasibility and acceptance for the patient on the long term.