Published online Nov 7, 2019. doi: 10.3748/wjg.v25.i41.6172
Peer-review started: September 8, 2019
First decision: September 19, 2019
Revised: September 26, 2019
Accepted: October 30, 2019
Article in press: October 30, 2019
Published online: November 7, 2019
In recent years, there has been a critical change in treatment paradigms in inflammatory bowel diseases (IBD) triggered by the arrival of new effective treatments aiming to prevent disease progression, bowel damage and disability. The insufficiency of symptomatic disease control and the well-known discordance between symptoms and objective measures of disease activity lead to the need of reviewing conventional treatment algorithms and developing new concepts of optimal therapeutic strategy. The treat-to-target strategies, defined by the selecting therapeutic targets in inflammatory bowel disease consensus recommendation, move away from only symptomatic disease control and support targeting composite therapeutic endpoints (clinical and endoscopical remission) and timely assessment. Emerging data suggest that early therapy using a treat-to-target approach and an algorithmic therapy escalation using regular disease monitoring by clinical and biochemical markers (fecal calprotectin and C-reactive protein) leads to improved outcomes. This review aims to present the emerging strategies and supporting evidence in the current therapeutic paradigm of IBD including the concepts of “early intervention”, “treat-to-target” and “tight control” strategies. We also discuss the real-word experience and applicability of these new strategies and give an overview on the future perspectives and areas in need of further research and potential improvement regarding treatment targets and (“tight”) disease monitoring strategies.
Core tip: Inflammatory bowel diseases are chronic, progressive, immune-mediated disorders leading to disability and cumulative intestinal damage. There has been a major change in treatment paradigms favouring an early introduction of highly effective therapies, applying a treat-to-target approach to target composite clinical and endoscopical therapeutic endpoints and using close monitoring of objective markers of inflammation (with clinical, endoscopical and biomarker assessment) to direct therapeutic decisions until these goals are reached. Although several data support the benefit of ‘treat-to-target’ and “tight control” strategies so far, these approaches require further validation assessing long-term outcomes and more precise definition of therapeutic targets (for both endoscopic and biomarker monitoring).