¿Cómo han evolucionado los objetivos de tratamiento en la práctica clínica?

La curación endoscópica como objetivo a largo plazo

Recomendaciones Treat to target4

ACG: American College of Gastroenterology; ECCO: European Crohn’s and Colitis Organisation; CM: Curación mucosa

¿Qué dicen las guías?

"Se recomienda tratar a
los pacientes con CU
para alcanzar la curación mucosa... con el objetivo de aumentar la probabilidad
de remisión sostenida libre de esteroides y prevenir las hospitalizaciones y la cirugía.2"

— Guías ACG 2019

"Varios estudios determinaron el beneficio
de la curación mucosa
en pacientes con CU. Un consenso internacional ha recomendado recientemente la curación mucosa como
un importante objetivo terapéutico para la CU.3"

— Guías ECCO 2019

Referencias

  1. Turner D, Ricciuto A, Lewis A, et al; International Organization for the Study of IBD. STRIDE- II: an update on the selecting therapeutic targets in inflammatory bowel disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD. Gastroenterology. 2021;160(5):1570- 1583..
  2. Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019;114(3):384-413.
  3. Maaser C, Sturm A, Vavricka SR, et al. ECCOESGAR guideline for diagnostic assessment in IBD part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis. 2019;13(2):144-164.
  4. Shah SC, Colombel JF, Sands BE, Narula N. Mucosal healing is associated with improved long-term outcomes of patients with ulcerative colitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(9): 1245-1255.e8.
  5. Barreiro-de Acosta M, Vallejo N, de la Iglesia D, et al. Evaluation of the risk of relapse in ulcerative colitis according to the degree of mucosal healing (Mayo 0 vs 1): a longitudinal cohort study. J Crohns Colitis. 2016;10(1):13-19.
  6. Boal Carvalho P, Dias de Castro F, Rosa B, Moreira MJ, Cotter J. Mucosal healing in ulcerative colitis – when zero is better. J Crohns Colitis. 2016;10(1):20-25.
  7. Peyrin-Biroulet L, Bressenot A, Kampman W. Histologic remission: the ultimate therapeutic goal in ulcerative colitis? Clin Gastroenterol Hepatol. 2014;12(6):929-34.e2.
  8. Cohen R, Skup M, Ozbay AB, et al. Direct and indirect healthcare resource utilization and cost associates with ulcerative colitis in a privately-insured employed population in the US. J Med Econ. 2015;18(6):447-456.
  9. Rowe WA, Anand BS. Inflamatory bowel disease. Medscape website. https://emedicine. medscape.com/article/179037-overview#a6. Published April 10,2020.
  10. Crosn ́s & Colitis Foundation. About Crohn ́s disease and ulcerative colitis. http//www. crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/IBDoverview.pdf. Published June 2018. Accesed June 9,2021.
  11. Khan HM, Mehmood F, Khan N. Optimal Management of steroid-dependent ulcerative colitis. Clin Exp Gastroenterol. 2015;8:293-302.
  12. Piercy J, Ozbay AB, Roughley A, Chao J, Skup M. Comparison of ulcerative colitis with Crohn ́s disease from the perspective of patient burden. Poster presented at: Digestive Disease Week; May 17-19,2015; Washington, DC, Poster Tu1256.
  13. Ye X, Wang HHX, et al. Can fecal calprotein accurately identify histological activity of ulcerative colitis? A meta-análisis. Therap Adv Gastroenterol. 2021;14:1756284821994741. doi:10.1177/1756284821994741
  14. Agrawal M, Spencer EA, Colombel JF, Ungaro RC. Approach to teh Management of recently diagnosed inflammatory bowel disease patients: a user ́s guide for adult and pediatric gastorentorologist. Gastroenterology. 2021;161(1):47-65. doi:10.1053/gastro.20221.04.063

JAKa-AR-00028-MC