IBD therapy: New targets and unmet needs

Inflammatory bowel diseases (IBD) are chronic progressive diseases. Current therapeutic strategies have not significantly altered the natural history of IBD. In the wake of other chronic diseases, such as rheumatoid arthritis, the goal of therapy has now shifted from mere control of symptoms to altering natural history to prevent bowel damage and disability. A 'treat to target' approach using endoscopic healing as a first definition of the target is now proposed together with tight control of inflammation based on monitoring of symptoms and biomarkers. In order to reach the target, optimization of current therapies using better understanding of pharmacokinetics is needed as well as development of predictors of disease progression to avoid under- and overtreating. Advances in the understanding of the roles of the adaptive and innate immune systems, as well as the intestinal epithelium and endothelium have resulted in the development of multiple new biologics. There is great optimism that an integrated 'omics' approach incorporating genetic, microbiota with clinical and environmental data will help in choosing for each patient a personalized approach targeting the mechanisms driving the disease. Finally, in this era of increasing complexity of care, education of patients to involve them in a well-informed decision-making process is mandatory.