About this Research Topic
Inflammatory bowel disease (IBD) is a group of idiopathic chronic inflammatory intestinal conditions and has become more prevalent over the last 30 years. Although there are few epidemiologic data from developing countries, the incidence and prevalence of IBD are expected to increase with time and in different regions around the world, indicating its emergence as a global disease. For example, 1% of Canadians are expected to suffer from one of these diseases by 2030, which is approximately 50% more patients than today.
Incidents appear more and more often, with accelerating incidence in newly industrialised countries whose societies have become more westernised. However, recent scientific advances aided into understanding the pathophysiology of IBD, making an early diagnosis and developing prevention strategies and innovations in health-care systems to manage this complex and costly disease.
More specifically, twenty years ago, Ulcerative Colitis (UC), one of the two main forms of IBD, was treated by steroids, salycilates, thiopurines and more rarely cyclosporin. Research has brought anti-tumor necrosis factor (anti-TNF) therapy at the forefront, according to which patients take TNF antagonists, such as infliximab, adalimumab and golimumab to induce and maintain remission in UC, while in case of TNF antagonist failure, vedolizumab is administered for the same reason. More recently, tofacitinib entered the market as an effective induction therapy and other immunosuppressive drugs are expected to be launched in the near future.
Nevertheless, clinical decisions in many scenarios are simply intuitive with no hard evidence guiding neither patients nor physicians. How do you decide when it is better to administer a biologic than an immunosuppressant in steroid-dependent patients? Should we recommend to a particular patient to abandon infliximab after 4 years of clinical inactivity or not? Should we use a combination or mono-therapy? In just a sole clinical session, these type of questions arise in the head of the clinician, who has no tools to make specific individualized decisions: prediction is key.
With the emergence of personalized medicine in several conditions, we should swift our treatment strategies to individual predictions. This Research Topic aims to answer:
-What is the status of individual prediction in 2020 in IBD?
- How can we improve prediction in the next decade?
- Is personalized medicine effective and cost-effective for the treatment of IBD?
Keywords: IBD, inflammatory bowel disease, intestinal inflammation, global disease, ulcerative colitis, incidence, prevalence, environmental factors
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