Time to clinical response and remission for therapeutics in inflammatory bowel diseases: what should the clinician expect, what should patients be told?

作     者：Abhinav Vasudevan Peter R Gibson Daniel R van Langenberg 

作者机构：Department of Gastroenterology and HepatologyEastern HealthBox Hill Hospital Monash UniversityEastern Health Clinical School Department of GastroenterologyAlfred Health and Monash University 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2017年第23卷第35期

页      面：6385-6402页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：AbbVie Janssen Falk Pharma Danone A2 Milk Company Ferring Shire 

主　　题：Crohn’s disease Clinical pharmacology Ulcerative colitis Thiopurines Inflammatory bowel disease Biologics nutrition 

摘      要：An awareness of the expected time for therapies to induce symptomatic improvement and remission is necessary for determining the timing of follow-up, disease(re)assessment, and the duration to persist with therapies, yet this is seldom reported as an outcome in clinical trials. In this review, we explore the time to clinical response and remission of current therapies for inflammatory bowel disease(IBD) as well as medication, patient and disease related factors that may influence the time to clinical response. It appears that the time to therapeutic response varies depending on the indication for therapy(Crohn s disease or ulcerative colitis). Agents with the most rapid time to clinical response included corticosteroids, calcineurin inhibitors, exclusive enteral nutrition, aminosalicylates and anti-tumor necrosis factor therapy which will work in most patients within the first 2 mo. Vedolizumab,methotrexate and thiopurines had a longer time to clinical response and can take several months to achieve maximal efficacy. Factors affecting the time to clinical response of therapies included use of concomitant therapy, disease duration, smoking status, disease phenotype and advanced age. There appears to be marked variation in time to clinical response for therapies used in IBD which is further influenced by disease and patient related factors. Understanding the expected time to therapeutic response is integral to inform further decision making, maintain a patientcentered approach and ensure treatment is given an appropriate timeframe to achieve maximal benefit prior to cessation.