Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6385
Peer-review started: June 6, 2017
First decision: June 22, 2017
Revised: July 3, 2017
Accepted: August 15, 2017
Article in press: August 15, 2017
Published online: September 21, 2017
An awareness of the expected time for therapies to induce symptomatic improvement and remission is necessary for determining the timing of follow-up, disease (re)assessment, and the duration to persist with therapies, yet this is seldom reported as an outcome in clinical trials. In this review, we explore the time to clinical response and remission of current therapies for inflammatory bowel disease (IBD) as well as medication, patient and disease related factors that may influence the time to clinical response. It appears that the time to therapeutic response varies depending on the indication for therapy (Crohn’s disease or ulcerative colitis). Agents with the most rapid time to clinical response included corticosteroids, calcineurin inhibitors, exclusive enteral nutrition, aminosalicylates and anti-tumor necrosis factor therapy which will work in most patients within the first 2 mo. Vedolizumab, methotrexate and thiopurines had a longer time to clinical response and can take several months to achieve maximal efficacy. Factors affecting the time to clinical response of therapies included use of concomitant therapy, disease duration, smoking status, disease phenotype and advanced age. There appears to be marked variation in time to clinical response for therapies used in IBD which is further influenced by disease and patient related factors. Understanding the expected time to therapeutic response is integral to inform further decision making, maintain a patient-centered approach and ensure treatment is given an appropriate timeframe to achieve maximal benefit prior to cessation.
Core tip: There appears to be marked variation in time to clinical response for therapies used in inflammatory bowel disease which is further influenced by disease and patient related factors. The most rapid response can be expected with corticosteroids, calcineurin inhibitors, exclusive enteral nutrition, aminosalicylates and anti-tumor necrosis factor therapy (within 2 mo), while methotrexate, thiopurines and vedolizumab can take several months to achieve maximal response. There is a lack of reporting of the time to response of therapies in clinical trials for inflammatory bowel disease and this remains an area that should be addressed in future studies.