Optimizing biologic treatment in IBD: objective measures, but when, how and how often?

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Biologic agents have advanced inflammatory bowel disease (IBD) treatment.
• Persistent inflammation and bowel damage can occur despite clinical remission.
• Mucosal healing and deep remission are increasingly recognized as therapeutic goals within a treat-to-target strategy.

Purpose of the Study:

• To review objective measures for monitoring IBD patients, particularly those on biologic therapies.
• To discuss the application of these measures across various clinical scenarios.
• To guide clinicians in the practical monitoring of IBD patients.

Main Methods:

• Concise review of objective monitoring parameters for IBD patients.
• Focus on patients treated with infliximab, adalimumab, vedolizumab, and other biologics.
• Discussion of measures during induction, maintenance, loss of response, and therapy cessation.

Main Results:

• Objective measures are crucial for assessing treatment efficacy beyond clinical remission.
• Monitoring is essential during all phases of biologic therapy.
• The review delineates specific parameters for different clinical situations.

Conclusions:

• Proactive monitoring combining inflammatory and pharmacokinetic measures is beneficial for moderate-to-severe IBD patients on biologics.
• Further research is needed to define optimal parameters, thresholds, and cost-effective interventions.
• Personalized monitoring strategies are key for optimizing biologic therapy in IBD.