Keep Calm and Treat to Target in Inflammatory Bowel Disease

Abstract

The goal of this symposium was to highlight the importance of early diagnosis, assessing prognostic factors, and treating to target in inflammatory bowel disease (IBD). In the introduction, Prof Colombel outlined the treat to target (T2T) and tight control (TC) approach, which involves predefining treatment targets in consultation with patients, continuously monitoring disease activity, and modifying treatments until targets are achieved. Dr Pariente presented regarding the progressiveness of Crohn’s disease (CD) and described the Lémann index (LI), which assesses cumulative structural damage in CD.1 He outlined the ‘window of opportunity’ in early disease, within which disease progression could be stopped. Dr Pariente said the T2T approach presents the opportunity for a personalised method of treatment; if targets are not achieved, treatment is intensified or switched. Prof Colombel presented the results of the CALM study,2 in which CD patients were randomised 1:1 to clinical management (CM) or TC, meaning treatment was escalated based on clinical symptoms in combination with biomarkers. The primary endpoint of mucosal healing and no deep ulceration was achieved by 45.9% of patients in the TC arm versus 30.3% in the CM arm (p=0.010). Lastly, Prof D’Haens presented a cost-effectiveness analysis using data from CALM. The calculated total direct medical costs for the TC arm were £13,296 versus £12,627 for the CM arm (a direct medical cost difference of £669).3 The quality-adjusted life years (QALY) were 0.684 for the TC arm versus 0.652 for the CM arm (giving a QALY difference of 0.032). The incremental cost-effectiveness ratio showed a cost of £20,913 per QALY gained, which falls within the threshold of The National Institute for Health and Care Excellence (NICE) guidance for cost-effectiveness.