Is this the most exciting time in IBD?

I'm in Valencia, a beautiful city with fantastic architecture, history and culture. At a meeting last night, one of the organisers remarked, "Charlie, this surely is the most exciting time in IBD." It caused me to reflect.

The Current State of IBD Care

It's 2024, and I think it probably is the most exciting era in inflammatory bowel disease management. It's hard to think of many other areas of medicine with quite so much promise on the horizon, although this can certainly be overstated.

I speak to this from the academic and research perspectives, but most importantly, from what I witness in the clinic - especially with newly diagnosed IBD patients. We now have an extensive toolkit of new and effective therapies, monitoring strategies, and holistic treatment paradigms to help patients achieve true remission - not just mucosal healing, but complete multi-dimensional wellness.

Is it perfect?

No. But what's emerging should give considerable hope to patients and clinicians alike.

The Improving Landscape of Drug Access

The drugs entering the clinic today are making a tremendous difference.

And it won't be long before today's novel therapies become affordable generics or biosimilars. We're only 5-10 years away from all of our current medications being off-patent. That may seem an eternity, but rewind just a decade, and we've already seen the transformative biosimilar anti-TNF era unfold - finally allowing us to use these drugs early and aggressively as intended.

Early effective therapy clearly improves outcomes.

We’ve been doing it for 10 years. And as a result more patients are in deep remission with fewer disease progressions events - including surgeries and hospitalisations - and markedly improved quality of life.

But a substantial unmet need remains - a therapeutic gap.

Too many treatments still aren't good enough, and the majority of our patients aren't newly diagnosed.

They've lived with Crohn's or ulcerative colitis for years, accumulating bowel damage that may be irreversible. Chronic inflammation elevates risks of cardiovascular and other co-morbidities.

Many patients have multi-refractory disease not responding to any therapies. Newer treatments studied in combination offer transformative potential - exponentially influencing inflammatory pathways. Regimens like VEGA, combining p19 and anti-TNF, provide hope that rational multi-drug strategies will prove effective.

Emerging Technologies Advancing Care

Artificial intelligence and smart technologies are also rapidly advancing:

• AI can standardise colonoscopy scores, providing consistent assessments over time.

• Advanced mathematical models analyse dynamic inflammatory profiles.

• AI applied to histology uncovers added prognostic insights.

• Predictive algorithms guide patient management.

• Wearables passively monitor physiologic metrics contributing to holistic care.

• Early technologies like cytokine-measuring sweat patches show promise.

Our Aspirations for IBD Patients

Ultimately, we need frictionless passive monitoring, effective therapies with excellent safety profiles, psychological support, dietary strategies and more to control IBD for most patients.

But that's not enough - we need to aim beyond deep remission with mucosal healing and histologic healing, to disease clearance potentially leading to cure.

Prevention is also critical as inflammatory bowel diseases continue their global spread. Physicians worldwide witness the rapidly increasing prevalence and wonder how to stop it. That's a topic for further discussion.

A Hopeful Outlook

For now, this is a message of hope to the worldwide IBD community - clinicians, multidisciplinary teams, academics, industry, policymakers and most importantly, patients and families.

While much work remains, the future is bright. Things are improving in clinics today. We have a duty to ensure this level of care becomes the widespread standard of practice.

More from me later this week. Thanks for reading.