Search

Drug classes offer convenient clinical shorthand but obscure meaningful differences between individual therapies in inflammatory bowel disease. As treatment options expand, moving beyond class effects towards drug-level selection informed by pharmacology, efficacy, safety and patient context is essential to deliver more precise care.

MRI could be used by clinicians as an effective tool to monitor patients with Crohn's disease. In this Review, Gionata Fiorino, Cristiana Bonifacio, Luca Balzarini, Alberto Malesci and Silvio Danese discuss the development of objective MRI-based scores that enable evaluation of the extent of intestinal damage. They also speculate on the generation of a new 'damage-driven' treatment paradigm—in which imaging is used to monitor intestinal damage and medication use is targeted to prevent the accumulation of further damage

Massimino et al. propose the Inflammatory Bowel Disease Transcriptome and Metatranscriptome Meta-Analysis (IBD TaMMA) framework, an open-source platform for expediting the investigation of IBD-specific transcriptomics and metatranscriptomics signatures.

The landscape of treatment for IBD changed dramatically with the introduction of biologic agents, of which several are now in use for this condition. Here, the authors provide practical insights into the use of biologic agents in IBD, discussing issues such as comparative effectiveness, safety, immunogenicity, cost and patient preference.

A recent study in a mouse model of colitis has demonstrated that interleukin (IL)-13, through inhibition of the mixed type 1 and type 17 T-helper cell inflammatory response, has a protective effect. The decoy receptor IL-13Rα2 inhibits this protective effect, suggesting blockade of IL-13Rα2 as a potential therapy for patients with IBD.

Evidence from a recent study strongly implicates innate immunity in the etiology of Crohn's disease, with particular focus on impaired secretion of cytokines and chemokines by intestinal macrophages in response to bacterial stimuli. These findings highlight the importance of acute inflammatory responses in the first stages of disease pathogenesis.

Evidence has accumulated to show that mucosal healing can alter the course of Crohn's disease. New results from the EXTEND trial clearly demonstrate that adalimumab is able to induce and maintain mucosal healing in Crohn's disease and has the potential for disease modification.

Therapy for Crohn's disease has traditionally been based on a step-up approach, with treatment with the powerful TNF antagonists reserved as a last resort before surgery. In this Review, the authors discuss the use of anti-TNF agents as first-line therapy to achieve disease modification and the challenges in selecting appropriate patients for this approach.

In 2013, several new IBD drugs, including golimumab and vedolizumab, have been approved or completed successful programmes, showing efficacy in both Crohn's disease and ulcerative colitis. In addition, classic IBD drugs have been formulated for colonic delivery, such as budesonide MMX^®, which was recently approved for mild-to-moderate ulcerative colitis.

Golimumab, a human anti-TNF antibody, is effective in patients with ulcerative colitis, according to new findings from an international phase III double-blind trial. The addition of this drug makes a ménage à trois of available drugs—comprising infliximab, adalimumab and golimumab—for the treatment of ulcerative colitis.

In this Review, Ma and colleagues discuss the evolution in clinical trial designs for inflammatory bowel disease (IBD), their implications for clinical care, and identify future directions for the next generation of IBD studies.

A new case report of successful treatment of refractory ulcerative colitis with CD19-directed chimeric antigen receptor T cell therapy sheds light on the role of B lineage cells in disease pathogenesis and the possibility of an ‘immune reset’. This approach could reshape therapeutic strategies, although its long-term efficacy, safety and positioning remain open questions.

Biosimilar monoclonal antibodies are now being accepted in clinical practice by IBD specialists. However, switching patients already undergoing originator biologic treatment to biosimilars has been debated due to lack of controlled studies. The NOR-SWITCH study now provides novel clinical evidence in switching from originator to biosimilar in patients with IBD.

A substantial percentage of patients with inflammatory bowel disease (IBD) exhibit biologic treatment failure or loss of response over time. This article explores the effectiveness and safety of monoclonal antibodies targeting the IL-23 pathway in treating IBD; continued research is needed to address lingering questions regarding long-term safety and efficacy.

Therapeutic advances in inflammatory bowel disease (IBD) have been universally directed towards patients with established disease to control inflammation, ameliorate symptoms and hinder disease progression, but preventing IBD development or delaying its onset are highly attractive. This Comment discusses the emerging approaches and future promises of interventional disease prevention trials in IBD.

Leukocytes enter inflamed tissues by initiating selectin-dependent rolling on reactive endothelia. Mantovani and colleagues show that the long pentraxin PTX3 competes for P-selectin and acts to limit neutrophil extravasation.

Data on the efficacy and safety of SARS-CoV-2 vaccines are now available, but evidence for these vaccines in those who are immunocompromised (including patients with inflammatory bowel diseases) are lacking. As vaccination begins, questions on advantages and disadvantages can be partially addressed using the experience from other vaccines or immune-mediated inflammatory disorders.

The European Medicines Agency safety committee has revisited the label and recommended the use of Janus kinase inhibitors in patients with certain risk factors only if no suitable treatment alternatives are available. Although regulatory decisions are key to place therapeutic options based on safety, broad restrictions might lead to unintended consequences without an individualized benefit–risk evaluation.

In ulcerative colitis, treating beyond endoscopic healing has shown a reduction of relapse and hospitalization, pushing for histological remission to be embraced in clinical practice and clinical trials. Here, we propose the concept of disease clearance (symptomatic, endoscopic and histological remission) as the ultimate goal in the treatment of ulcerative colitis.

The coronavirus disease (COVID-19) worldwide outbreak has led to a dramatic challenge for all healthcare systems, including inflammatory bowel disease (IBD) centres. Here, we describe the fast changes and clinical issues that IBD specialists could face during this SARS-CoV-2 infection pandemic, highlighting the potential rearrangements of care and resetting of clinical priorities.

During the coronavirus disease 2019 (COVID-19) pandemic, inflammatory bowel disease (IBD) practices have been disrupted. This Comment summarizes the key strategies that should be implemented for both patients and IBD specialists to provide optimal care while avoiding new outbreaks for the first 6–12 months after the peak of the COVID-19 pandemic.

The management of inflammatory bowel disease (IBD) continues to evolve. This Review is a practical guide on the therapeutic toolkit for IBD, with a focus on current and emerging IBD medications, how they relate to management strategies beyond drugs and the importance of the clinician–patient relationship.

Biologic agents have revolutionized the management of IBD and biosimilars (copy versions of the originator agents) are emerging as an alternative. This Review outlines the concept of biosimilars and their adoption in gastroenterology, their current use and future challenges.

Epigenetic perturbations may be an important factor in diseases where both genes and environment play a role. Here, Ventham and colleagues show that DNA methylation changes in inflammatory bowel disease are related to the underlying genotype, and are associated with cell-specific changes to gene expression.

Inflammatory bowel disease (IBD) is an immune-mediated disease with substantial burden worldwide. In this Consensus Statement, a global multidisciplinary group of experts identify key priorities and recommendations to raise awareness and advance IBD care and research.

Drug discovery and development for inflammatory bowel disease (IBD) is hampered by various challenges including the insufficient mechanistic understanding of IBD immunopathology, disease heterogeneity, inadequate preclinical models and clinical trial inefficiencies. This Perspective assesses these limitations and presents strategies to overcome them, including the integration of artificial intelligence and machine learning approaches, organoid technology and innovative trial designs.

In this Review, the authors explore potential applications of big data in IBD research, including predictive models of disease course and response to therapy, characterization of disease heterogeneity, drug safety and development, precision medicine and cost-effectiveness of care.

Most of the more than 200 known genetic risk loci for inflammatory bowel disease (IBD) reside in regulatory regions. Here, the authors provide eQTL datasets for six circulating immune cell types and ileal, colonic and rectal biopsies to map regulatory modules and identify potential causative genes for IBD.

Ulcerative colitis is a chronic inflammatory bowel disease affecting the rectum and the colon. This Primer describes the epidemiology, the current understanding of ulcerative colitis pathophysiology and its diagnosis. In addition, Hibi and colleagues highlight the current and emerging therapeutic strategies and discuss the most pressing questions in the field.

The COVID-19 pandemic has resulted in changes to the management of patients with inflammatory bowel disease, including major disruptions to endoscopy. This Perspective provides a guide and recommendations for inflammatory bowel disease endoscopy during a global health emergency based on expert experience in Italy and France.

In this article, the authors summarize the latest clinical and basic research on gut inflammation in spondyloarthritis and highlight important questions to address in future research.

Crohn’s disease is a progressive, destructive inflammatory bowel disease of unclear cause and involves chronic inflammation of any part of the gastrointestinal tract. This Primer reviews the epidemiology, pathophysiology, diagnosis and management of this disease.

Intestinal fibrosis is an important feature of inflammatory bowel disease (IBD) that remains poorly understood. Here, D’Alessio and Ungaro et al. review the cellular and molecular mechanisms contributing to intestinal fibrosis and discuss future therapeutic strategies for IBD-related fibrosis.

Patients with inflammatory bowel disease (IBD) are at increased risk of thrombotic events. This Evidence-Based Guideline presents an international consensus on the prevention of venous and arterial thrombotic events in patients with IBD, and includes 19 recommendations for clinical practice.

Colonic diverticular disease, characterized by sac-like protrusions on the wall of the large intestine, is one of the most common conditions detected on colonoscopy in the adult population. This Primer by Tursi and colleagues reviews the epidemiology, pathophysiology, diagnosis and management of this disease.

As the number of novel drugs for inflammatory bowel disease (IBD) increases, comparison of therapeutic options has become a key challenge in IBD trials. Here, the authors provide an overview of IBD trial design with a focus on comparative research and the head-to-head trials format.