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Review
. 2020 Jul 3;8(7):193.
doi: 10.3390/biomedicines8070193.

The New Proactive Approach and Precision Medicine in Crohn's Disease

Eran Zittan  1 , Ian M Gralnek  1   2 , Marc S Berns  2
Affiliations
Review

The New Proactive Approach and Precision Medicine in Crohn's Disease

Eran Zittan et al. Biomedicines. .

Abstract

The proactive approach to Crohn's disease (CD) management advocates moving toward algorithmic tight-control scenarios that are designed for each CD phenotype to guide remission induction, maintenance therapy, active monitoring, and multidisciplinary care to manage the complexities of each inflammatory bowel disease (IBD) patient. This requires accurate initial clinical, laboratory, radiological, endoscopic, and/or tissue diagnosis for proper phenotypic stratification of each CD patient. A substantial proportion of patients in symptomatic remission have been reported to demonstrate evidence of active disease, with elevated fecal calprotectin(FC) and C-reactive protein (CRP) levels as a hallmark for mucosal inflammation. Active mucosal inflammation, and elevated CRP and fecal calprotectin (FC) have been shown to be good predictors of clinical relapse, disease progression, and complications in IBD patients. The next frontier of treatment is personalized medicine or precision medicine to help solve the problem of IBD heterogeneity and variable responses to treatment. Personalized medicine has the potential to increase the efficacy and/or reduce potential adverse effects of treatment for each CD phenotype. However, there is currently an unmet need for better elucidation of the inflammatory biopathways and genetic signatures of each IBD phenotype, so personalized medicine can specifically target the underlying cause of the disease and provide maximal efficacy to each patient.

Keywords: Crohn’s disease; IBD; objective measurement; tight control; treat-to-target.

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Conflict of interest statement

E.Z. has received research support and consulting fees from Janssen, Abbvie, Takeda, Neopharm and Pfizer. I.M.G. has received lecture fees from Astra-Zeneca, Taro Pharma, Vifor Pharma and 3D Matrix; he is a paid consultant for Boston Scientific, GI View, Motus GI and Symbionix; Prof Gralnek is a member of the Medical Advisory Board of Motus GI. M.S.B. declares no conflict of interest.

Figures

Figure 1
Figure 1
Bottom-up vs. top-down therapy.
Figure 2
Figure 2
The new proactive algorithm.
See this image and copyright information in PMC

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