Are we ready for top-down therapy for inflammatory bowel diseases: pro

Abstract

Until the 1990s, inflammatory bowel diseases (IBD) were treated with conventional drugs, such as mesalazine, corticosteroids and thiopurines, which are effective in a proportion of IBD patients. Despite the introduction of immunosuppressive drugs, a significant number of IBD patients have a disabling disease course and, on average, a poor quality of life. The discovery of anti- TNF trategies and the development of biologics targeting several other pathways, important in the pathogenesis of ulcerative colitis and Crohn’s disease, introduced a pivotal discussion. Central to this discussion is the question of whether these new therapies should be introduced early or late in the course of the disease. Important factors that are relevant for this discussion are quality of life, need for corticosteroids and surgery. This article aims to explore whether we are indeed ready for a top-down approach toward biologics.

Keywords::

• Crohn’s disease
• disease course
• immunosuppressive therapy
• quality of life
• step up
• top down
• ulcerative colitis

Financial & competing interests disclosure

Dr van der Woude and Dr Hommes have received fees and research grants from Abbott, UCB, Centocor and Schering Plough. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.