Endoscopy as a Diagnostic Tool for Personalized Therapy in IBD: Prediction of Response to Biological Therapy

Both Crohnʼs disease [1] and ulcerative colitis [2] are chronic relapsing disorders of the gastrointestinal tract that are characterized pathologically by intestinal inflammation. Both inflammatory bowel disease (IBD) entities are progressive conditions that can lead to bowel damage and disability, having a major impact on an individualʼs quality of life. Furthermore, ongoing inflammatory activity is causative for occurrence of strictures, fistula, abscesses, as well as heightened incidence of colitis-associated neoplasia. Optimized anti-inflammatory therapy is therefore essential in the management of IBD patients [1], [2]. Advances in understanding the underlying immunopathogenesis in ulcerative colitis have led to the development of biological therapies, which selectively inhibit crucial pathways of involved inflammatory processes. Blockade of the pro-inflammatory cytokine tumor necrosis factor (TNF) by neutralizing antibodies was the first approved treatment modality, which was complemented by the anti-adhesion antibody vedolizumab directed against the α4β7 integrin. Subsequently, the anti-IL-12/IL-23p40 antibody ustekinumab and the JAK-inhibitor tofacitinib have broadened our therapeutic armamentarium. In spite of their effectiveness, it was found that only subgroups of IBD patients benefit from these therapies. Depending on the duration and the clinical endpoints chosen, only 30 – 60% of patients will show an improvement of active disease. There is therefore the currently unmet clinical need to predict therapeutic responses prior to the initiation of therapy. Reliable prediction would enable the treating physician to directly introduce the patient to the most efficient therapy, which would enable time-efficient control of the disease and prevent the onset of irreversible structural damage. This would also be essential to avoid exposure of patients to associated potential side effects of an inefficient therapy and reduce the substantial costs of an inappropriate therapy for the health care systems [3].

Publication History

Article published online:
17 November 2021

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