Mucosal healing in inflammatory bowel disease: Maintain or de-escalate therapy

Abstract

In the past decade, thanks to the introduction of biologic therapies, a new therapeutic goal, mucosal healing (MH), has been introduced. MH is the expression of an arrest of disease progression, resulting in minor hospitalizations, surgeries, and prolonged clinical remission. MH may be achieved with several therapeutic strategies reaching success rates up to 80% for both, ulcerative colitis (UC) and Crohn's disease (CD). Various scoring systems for UC and for the transmural CD, have been proposed to standardize the definition of MH. Several attempts have been undertaken to de-escalate therapy once MH is achieved, thus, reducing the risk of adverse events. In this review, we analysed the available studies regarding the achievement of MH and the subsequent treatment de-escalation according to disease type and administered therapy, together with non-invasive markers proposed as predictors for relapse. The available data are not encouraging since de-escalation after the achievement of MH is followed by a high number of clinical relapses reaching up to 50% within one year. Unclear is also another question, in case of combination therapies, which drug is more appropriate to stop, in order to guarantee a durable remission. Predictors of unfavourable outcome such as disease extension, perianal disease, or early onset disease appear to be inadequate to foresee behaviour of disease. Further studies are warranted to investigate the role of histologic healing for the further course of disease.

Systematic review: outcomes and adverse events from randomised trials in Crohn's disease

“…A secondary analysis considered the reporting of outcomes were not specified as primary or secondary endpoints. To mirror the increased focus on the importance of mucosal healing, the number of studies that reported additional endoscopic or histologic outcomes or the faecal calprotectin biomarker was assessed.…”

Treatment Patterns and Sequencing in Patients With Inflammatory Bowel Disease

“…1 Treatment of IBD aims to induce and maintain clinical remission and to promote mucosal healing via a range of pharmaceutical therapies tailored to the needs and the clinical response of individual patients. 1,2 Surgery is required in patients with refractory chronic or severe active disease in which pharmaceutical therapies have not been successful; however, surgery is typically seen as a last resort and is not always curative, particularly in CD. 1,3 In patients with mild to moderate UC, current US guidelines recommend first-line treatment with aminosalicylate (5-ASA) or sequential induction with corticosteroids (CS) followed by 5-ASA maintenance therapy.…”

The efficacy and safety of sulindac for colorectal polyps

“…Neoplastic polyps mainly refer to adenomatous polyps, with a high probability of canceration, which is the most important precancerous disease of colorectal cancer and has a rising trend in recent years. [ 11 ]…”