The Future of IBD Therapy: Where Are We and Where Should We Go Next?

Abstract

Background: The advent of biologic agents opens up a new era for the treatment of inflammatory bowel disease (IBD). In this era, the treatment goal has evolved from the traditional goal of clinical remission to a combination of clinical remission, laboratory normalization and mucosal healing, designated as ‘complete deep remission'. Such complete deep remission comprises a more ambitious disease control strategy that is believed to probably modify the natural course of IBD. Key Messages: To achieve this goal, optimization of current strategy and introduction of novel therapies have gained significant interest. In this concise review, we aim to provide an overview of the current status and future direction of IBD treatment. Specifically, we will describe the application of personalized therapy, development of new biologics, intestinal microbiome manipulation and out-of-the-box agents for IBD. Conclusions: More evidence is still desirable to better optimize the current treatment and apply novel biologics. Personalized medicine has the potential to optimize efficacy, decrease the risk of adverse events and minimize costs and should be proposed as a standard of care for the management of IBD.

Usefulness of Different Pathological Scores to Assess Healing of the Mucosa in Inflammatory Bowel Diseases: A Real Life Study

“…To date, the concept of “remission” for patients with IBD has evolved from mere clinical aspects and includes endoscopic remission, in addition to clinical remission and laboratory normalization 1, 14, 15 . However, it is a matter of fact that an endoscopic remission is not always paralleled by a histologically quiescent disease 16–18 , and that obtaining both endoscopic and histological healing provides the best chances for a sustained remission 19 .…”

“…In particular, there had been an evolution of the concept of treatment goals, shifting from the traditional one of clinical remission to a combination of clinical remission, laboratory normalization, and mucosal healing, the so-called “complete deep remission” 1 . Of interest, the concept of “deep remission” is evolving, and in the future will probably include the histological healing aspects in both Crohn’s disease (CD) and ulcerative colitis (UC) patients 2 , since it is increasingly clear that endoscopic remission is not necessarily paralleled by histological healing of the mucosa 3 .…”

Propionate Ameliorates Dextran Sodium Sulfate-Induced Colitis by Improving Intestinal Barrier Function and Reducing Inflammation and Oxidative Stress

“…Glucocorticoids, sulfasalazine, and immunosuppressive drugs have been traditionally used for the treatment and maintenance of ulcerative colitis. However, clinical application of these drugs is limited by their adverse effects ( Mao and Hu, 2016 ), and therefore there is an urgent need to seek alternative remedies.…”

Propionic Acid Targets the TLR4/NF-κB Signaling Pathway and Inhibits LPS-Induced Intestinal Barrier Dysfunction: In Vitro and In Vivo Studies

“…Clinically, anti-inflammatory drugs, steroids, and immunosuppressive drugs are traditionally used for the treatment of NEC or other intestinal inflammatory conditions (Suenaert et al, 2002;Cetin et al, 2004). However, the clinical application of these drugs is limited by their adverse effects, and there is therefore an urgent need to identify alternative remedies (Mao and Hu, 2016). PA, a final product of bacterial metabolism in the gut, is derived primarily from dietary fiber and has been reported to have extensive anti-inflammatory effects (Bolognini et al, 2016).…”