Monitoring of Therapy for Inflammatory Bowel Disease

Abstract

The monitoring of inflammatory bowel disease (IBD) based on clinical symptoms and activity scores alone has major drawbacks. Despite clinical remission, in many patients with ongoing low-grade inflammation and activity scores, there is a tendency to underestimate IBD activity as parameters depend on the subjective symptoms of the patients. C-reactive protein might identify patients with low-grade inflammation, especially in Crohn’s disease, but sensitivity remains limited. Recently, fecal markers of inflammation have been shown to correlate well with endoscopic disease activity and to predict relapse. However, data on serial measurements to guide therapy are scarce. The role of anti-TNF-α antibodies and plasma TNF-α concentrations in IBD therapy is currently unclear and needs to be defined further. The goal of improving disease outcome has not been demonstrated for any noninvasive biomarker so far.

Detection of Small Bowel Mucosal Healing and Deep Remission in Patients With Known Small Bowel Crohn’s Disease Using Biomarkers, Capsule Endoscopy, and Imaging

“…However, there are signifi cant limitations that have to be acknowledged. CRP is normal or modestly elevated in up to 30% of CD patients ( 8 ). FCP is accurately associated with colonic infl ammation; however, it is signifi cantly less reliable in SB disease ( 7,(10)(11)(12).…”

“…Approximately 30% of CD patients do not present with elevated CRP levels even during relapse ( 7,8 ). FCP is strongly correlated with colonic infl ammation, but its accuracy in isolated SB disease (9)(10)(11)(12) is limited.…”

Biomarkers of Inflammatory Bowel Disease

“…A meta-analysis collecting 13 studies including 1378 IBD patients shows the risk ratio (RR) of patients with ATIs failed treatment was 3.2 (95% CI: 2.0–4.9, P < 0.0001) when compared with non-ATIs or low-ATIs. Although there exists a bias in this study, the research recently shows ATIs concentration significantly correlated with the effect of treatment, so the concentration of ATIs seems to be quite important for patients with IFX [ 117 , 118 ]. Furthermore, the antibodies to F(ab′)2 exist in 67% ATI-positive patients; it is immunogenicity of ATI, but scholars declare ATIs are still more important than F(ab′)2 when there is effect-monitoring of IFX in IBD [ 119 ].…”

Therapeutic Strategy for Crohn's Disease with a Loss of Response to Infliximab: A Single-Center Retrospective Study

“…However, nearly one third of patients who achieve clinical remission under treatment with IFX lose their response to this therapy during their clinical course [8,10,11], presumably due to declines in the serum IFX level and antibodies to IFX (ATI) [12,13,14,15]. In cases involving a loss of response (LOR) to IFX, intensified therapeutic regimens, such as those comprising doubling the IFX dose, shortening the IFX interval or switching to other biologics, are alternative treatments [8,10,16,17,18].…”