Treating IBD: Disease Activity vs Severity

Distinguishing between disease activity and disease severity is an important component of treating inflammatory bowel disease (IBD), said Stephen Hanauer, MD, Clifford Joseph Barborka professor of medicine at Northwestern University's Feinberg School of Medicine and medical director of the Digestive Health Center in Chicago, Illinois

On Friday, April 27, Dr Hanauer presented “Redefining ‘Disease Severity’ in IBD” at the Interdisciplinary Autoimmune Summit 2018 in Boston, Massachusetts.
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Disease activity and severity are separate concepts, Dr Hanauer explained in his presentation.

Disease activity involves cross-sectional assessment of biologic inflammatory impact on signs, symptoms, histology, endoscopy, and biomarkers, whereas disease severity includes longitudinal and historical factors that more accurately depict prognosis and the overall burden of disease.

Both disease activity and severity can impact outcomes differently and should both be considered when forming an appropriate treatment regimen.

“Disease activity reflects the symptoms and endoscopic findings on the day of a visit,” Dr Hanauer explained. “Severity reflects the prognosis, as well. Therapies are directed at alleviating immediate symptoms (activity) but also should be directed to prevent disease progression (severity).”

He also emphasized the importance of early intervention with the right treatment, as patients with moderate- to high-risk disease require intensive therapy before irreversible tissue damage occurs.

Currently, biologics are the most effective drugs for IBD, Dr Hanauer said. However, they are currently only indicated for patients with moderately to severely active disease.

“A post-surgical patient has no disease activity but is at risk for disease recurrence (progression),” Dr Hanauer said. “We now advocate treating patients with low disease activity more aggressively to prevent progression.”

Ultimately, therapeutic goals for IBD should revolve around achieving sustained deep remission, as well as improving long-term outcomes, Dr Hanauer concluded.

—Christina Vogt

Reference:

Hanauer S. Redefining “disease severity” in IBD. Presented at: Interdisciplinary Autoimmune Summit 2018; April 27-29, 2018; Boston, MA.