Marla Dubinsky, MD

Experts continue the discussion on treat-to-target in CD, highlighting monitoring treatment response.

Monitoring Treatment Response in Treat-to-Target in CD

This is a video synopsis/summary of a panel discussion involving Marla Dubinsky, MD; David Rubin, MD; Miguel Regueiro, MD; Remo Panaccione, MD, FRCPC; and Sara Horst, MD, MPH.

The experts delve into the reassessment and monitoring strategies for patients undergoing treatment for Crohn's disease. The discussion revolves around determining when and how healthcare providers should assess if the patient is progressing in the right direction and whether the current treatment is effective.

The speakers emphasize the importance of early targets, including clinical response, clinical remission, and biomarker trends. They stress that if patients don't meet these early targets within a reasonable timeframe, there is a need to reassess the monitoring strategy. The concept of treat-to-target is discussed, where clinical response should be assessed within 4 weeks of initiating therapy.

The role of biomarkers, such as fecal calprotectin and c-reactive protein (CRP), is highlighted, with a suggestion to monitor them as early as week 4 and subsequently at 8 weeks, 12 weeks, and every 3 months. The biomarker trends help identify whether the therapy is working or if there's a need for intensification or a change in treatment.

The speakers also touch upon the challenge of convincing patients who feel well to undergo monitoring, emphasizing the importance of using patients as their own control. The goal is to establish a baseline understanding and ensure that even when patients are in endoscopic remission, ongoing monitoring remains crucial.

Overall, the discussion emphasizes the dynamic nature of monitoring strategies, adapting to individual patient responses, and using a combination of clinical, biomarker, and endoscopic assessments to guide treatment decisions effectively.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

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review the treat-to-target strategy in relation to CD management, and how treat-to-target moves beyond symptom control.

Treat-to-Target in CD

The experts discuss the evolving approach to treating Crohn's disease, emphasizing the importance of symptom control for patients who have been suffering. The immediate goal is to improve patients' well-being and allow them to live their lives without focusing solely on long-term treatment strategies like "treat to target."

The conversation addresses the historical progression in treatment goals, from focusing solely on symptom control to incorporating biomarkers such as C-reactive protein and fecal calprotectin. The panel acknowledges the constant evolution in setting treatment goals, moving towards more comprehensive measures like endoscopy and cross-sectional imaging, including ultrasound.

The speakers highlight the challenge of communicating the concept of treat to target to patients and colleagues, noting that the term "stride" may not be familiar to patients. The discussion revolves around educating patients about the evolution of treatment goals and the importance of addressing various aspects of the disease, including perianal disease, joint pain, fatigue, and inflammatory markers.

A scorecard analogy is introduced, with each aspect of the disease considered as a point that needs to be addressed. The "treat to target" strategy aims to decrease these points, bringing patients as close to normal as possible. The speakers emphasize the need for clear communication with patients, avoiding medical jargon, and focusing on collaborative efforts to achieve treatment goals.

The conversation concludes by underlining the importance of a follow-up plan and a clear cadence of moving forward. The treat-to-target strategy is portrayed as a collaborative effort between healthcare providers and patients to improve quality of life by abrogating inflammation and preventing complications. The emphasis remains on maintaining a balance between immediate symptom relief and achieving long-term treatment goals.

Miguel Regueiro, MD, and David Rubin, MD, review the treat-to-target strategy in relation to CD management, and how treat-to-target moves beyond symptom control.

early introduction of biologics in the treatment of CD, highlighting her approach to initiating conversations with patients about advanced therapy.

Starting Biologic Treatment Early in CD

In this discussion, the focus is on the importance of early intervention in treating Crohn's disease, emphasizing the need for timely initiation of advanced therapies. The speaker underscores the empathy and compassion felt towards patients who have endured prolonged suffering without experiencing well-being or health.

The conversation delves into the significance of treating Crohn's disease early, given its progressive nature. Data suggests that starting biologic therapies closer to the time of diagnosis is more effective than initiating them after 2 or 4 years, as the disease might have been silently progressing for an extended period before diagnosis.

The panel addresses the challenge of educating patients and colleagues about the urgency of starting advanced therapies as soon as possible. The difficulty lies in convincing individuals who have been living with the disease for several years to accept the necessity of immediate intervention.

The speaker emphasizes the need for disease control and frames the conversation around giving patients back a sense of control over their lives. The goal is to provide stability and prevent the waxing and waning of symptoms. The term "advanced therapies" is discussed, acknowledging its potential stigma and suggesting a shift towards focusing on effective treatment for Crohn's disease.

The discussion concludes with an emphasis on achieving long-term goals and protecting patients in the future by treating the disease early with the most effective agents. The speakers recognize the challenge of addressing this issue, especially with newly diagnosed patients who may find the concept overwhelming. Overall, the panel highlights the importance of early intervention and effective communication to ensure optimal outcomes for Crohn's disease patients.

Sara Horst, MD, MPH, comments on early introduction of biologics in the treatment of CD, highlighting her approach to initiating conversations with patients about advanced therapy.

symptoms of Crohn’s disease (CD) contribute to a patient’s quality of life, symptom control alone is not sufficient focus modifying the disease process.

Moving Beyond Symptom Control in CD

Experts discuss the challenges in managing chronic progressive diseases like ulcerative colitis and Crohn's disease, focusing on the use of certain medications. The speaker highlights the limited efficacy of steroids and mesalamine in altering the natural history of these diseases. While mesalamine may provide clinical relief for ulcerative colitis, there's no data supporting its effectiveness in Crohn's disease.

The conversation revolves around communicating treatment options to patients who may be hesitant to pursue advanced therapies due to safety concerns or uncertainty about readiness. The speaker emphasizes the importance of addressing symptoms comprehensively rather than relying on temporary solutions like steroids or placebo-like medications.

To enhance patient understanding, the speaker uses visual aids such as colonoscopy images and cross-sectional imaging to illustrate the consequences of bowel damage. The discussion aims to encourage patients to consider advanced therapies that can reverse damage and control inflammation, ultimately improving their quality of life and potentially avoiding surgery. The transcript emphasizes the predictability and manageability of Crohn's disease with the available therapies, providing hope for patients to achieve stability and avoid unexpected flare-ups.

Experts discuss the idea that, while symptoms of Crohn’s disease (CD) contribute to a patient’s quality of life, symptom control alone is not sufficient and the focus should be modifying the disease process.

Marla Dubinsky, MD

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