The future of IBD treatment

May 27, 2019

Inflammatory bowel disease (IBD) is an umbrella term that covers multiple diseases: Crohn’s disease, ulcerative colitis, and IBD unclassified.  Within each of these subtypes of IBD, there is variety in symptoms, severity, and the mechanics of the disease.  The common thread is chronic inflammation of the digestive tract, which leads to symptoms like diarrhea, abdominal pain, reduced appetite, fatigue, and weight loss.

Researchers recently discovered that there are also commonalities in genetic variations and in the gut microbiome of individuals with different types of IBD.  Because of these findings, researchers are looking at IBD differently.  The future of IBD treatment is in looking at the inflammation from fresh perspectives, creating a personalized diagnosis and treatment plan.

Genetic testing will be a part of these personalized plans of the future.  201 loci, specific areas of the genome, have already been associated with Crohn’s disease and ulcerative colitis.  The information at these 201 loci (more will be identified with time) provides insights into the mechanics of the disease and severity.  As more data is collected, correlations between this genetic information and responsiveness to different treatments will emerge.  At that point, genetic testing will not only provide diagnostic information, but it will guide the treatment plan as well.

Improved treatment plans have many long-term implications for patients, one of which relates to the likelihood of relapse.  A recent study concluded that a reduction in symptoms and inflammatory response within the first three months of diagnosis is a critical indicator of predicting relapse of IBD.

Current treatment for IBD includes exclusive enteral nutrition (a specific liquid diet), corticosteroids, and anti-TNF therapy.  Not all patients improve on the same treatment, so it is up to the clinician to determine how aggressive a treatment is warranted for each individual.  Less than 80% of patients see an improvement on the exclusive enteral nutrition treatment, and approximately 90% of patients have reduced symptoms with corticosteroids.  After the initial treatment plan, there is maintenance therapy to keep patients in remission.  Common therapies include 5-ASA derivatives, thiopurines, anti-TNF therapy, and dietary changes.  With the personalized treatments of the future, diagnostic testing will more precisely inform which therapies are best for each individual.

We should be seeing new treatment options soon.  IBD researchers are applying findings from cancer studies to develop avenues to affect the immune system to treat IBD.  Many past efforts focused on cytokines IL17, IL13, and IL10, all of which are key players in the immune response.  New studies are focused on JAK and SMAD7 inhibitors, which have been effective in treating numerous diseases where the inflammation is involved.

Follow the ETP blog for updates on these and other future treatments for IBD.

If you’re interested in more details, check out the following scholarly article.

Ashton JJ, Mossotto E, Ennis S, Beattie RM. Personalising medicine in inflammatory bowel disease-current and future perspectives. Transl Pediatr. 2019 Jan;8(1):56-69.

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