Crohn's Disease: Key Hopes and Understandings
JANUARY 24, 2018
MD Magazine Staff
Bruce E. Sands, MD: My hope for the future is that we’re going to be able to identify the right drug for the right patient at the right time and having more options for treatment will eventually allow us to do that. Having predictive biomarkers will allow us to choose the right drug for the right patient. Having the availability of therapeutic drug monitoring, particularly for biologic therapies, will help us fine tune the treatment. So, increasingly, we view this as very individualized treatment process tailored to each person and improving the results for everyone. I think that is well within our reach at this point.
Stephen B. Hanauer, MD: Ultimately, we’d like to identify biomarkers to select which patient is going to respond best to which therapy. But unfortunately, we don’t have that at the present time. I would like to see therapy for Crohn’s disease, rather than therapy for mild to moderate or moderate to severe Crohn’s disease. Those distinctions don’t really make clinical sense to us. We need to stop the inflammation and prevent the progression of the disease, and that would invoke early effective therapies, some of which we have. But we clearly have therapeutic gaps for many patients who don’t respond to our current treatment approaches.
William J. Sandborn, MD: When I look ahead to the 10 or 15 years that I plan to be in the field and the years to come, what I would really like to see is that we deliver the early use of combinations of drugs that prevent disease progression to stricture, fistula, abscess; prevent surgery; and really change the natural history of Crohn’s disease, which has been disease progression and surgery in decades past. I think we’re going to see that evolve over the next 10 years.
Marla Dubinsky, MD: 2032 will be the 100th anniversary of Crohn’s disease, the discovery of Crohn’s disease. We’ve got about 15 years to figure this out so we can actually say we understand what triggered that first patient who ever presented at Mount Sinai with Crohn’s disease and had a surgery instead. This was a new disease that we hadn’t seen before.
There has been evolution in industrialization, so microbiomes have changed from westernization in emerging countries. In X amount of time, there will be more IBD patients in Asia and India, for example, because the denominator is so large and there is change in environment, change in food, and change in microbiome, westernization, industrialization. We know we’ve got to track the microbiome, so there’s definitely a huge unmet need in understanding this better and developing therapies that can help change the microbiome in those who don’t even have IBD yet, but are at risk of developing it.
The field is very exciting, and there are a lot of parallel things happening. Obviously, the patients would like to never be dealing with the disease, and we agree. I think we should work on ultimate strategies that get them in such deep remission that we can maybe then use our microbial-based therapies to keep them there. So, that’s the exciting part of what the next 15 years is going to look like.
Transcript edited for clarity.