#NASPGHAN17 IBD Treat to Target and Tight Control

More information from this year’s annual NASPGHAN meeting.

This blog entry has abbreviated/summarized these presentations. Though not intentional, some important material is likely to have been omitted; in addition, transcription errors are possible as well.

IBD Treat to Target: Treat the Patient or Treat the Disease

Robert Baldassano  Children’s Hospital of Philadelphia

I missed the first few minutes of this presentation, even though I had highlighted this as one of my top priorities.  So, if anyone reading this post has some additional comments, they are certainly welcome.

Key points:

  • Do not rely on symptoms alone to assess patient improvement.
  • Best surrogate marker: calprotectin.  Frequent calprotectin levels can help determine objective improvement; it is much more helpful than CRP as ~25% of patients do not elevate their CRP levels
  • Therapeutic drug monitoring is important in improving outcomes. Dose optimization improves response rate and durability of infliximab response.
  • Evolving targets in ulcerative colitis.  Even histologic activity, in the absence of endoscopic activity, is associated with relapsing disease
  • Dr. Baldassano indicated that he no longer is starting patients on thiopurine therapy. There are “36 phase 3 trials underway.” Thus, many promising options for those who may burn through current treatments
  • This lecture reviewed data from the RISK study showing that early (1st 90 days w/in diagnosis) TNF therapy helps prevent penetrating disease (related post: CCFA Update 2017/RISK study)

Another presentation by Philip Minar et al (Cincinnati Children’s Hospital Medical Center) shows that CD64 suppression is an early biomarker of response to infliximab therapy.

2 thoughts on “#NASPGHAN17 IBD Treat to Target and Tight Control

  1. 1. Any data or guidance on how frequently to check calprotectin or how soon after a therapeutic intervention it should normalize?

    2. What’s being done to get widespread insurance acceptance of biologic monitoring (levels/ABs), (and at this point Prometheus has demonstrated a more reliable/useful test)?

    • Ben,

      1. I think the frequency of calprotectin monitoring is based on expert opinion, though there is plenty of data correlating with mucosal healing. The frequency in some centers is as often as every 3 months until improvement. If calprotectin is not low or trending in right direction, escalation of therapy could be needed.

      2. As far as insurance companies and coverage of therapeutic monitoring (& calprotectin), I am not an expert. I am aware that NASPGHAN has written advocacy letters (on their website) to help with coverage issues.

      Regards

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