Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2017; 23(35): 6385-6402
Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6385
Time to clinical response and remission for therapeutics in inflammatory bowel diseases: What should the clinician expect, what should patients be told?
Abhinav Vasudevan, Peter R Gibson, Daniel R van Langenberg
Abhinav Vasudevan, Daniel R van Langenberg, Department of Gastroenterology and Hepatology, Eastern Health, Box Hill Hospital, Box Hill, Victoria 3128, Australia
Abhinav Vasudevan, Daniel R van Langenberg, Monash University, Eastern Health Clinical School, Box Hill, Victoria 3128, Australia
Peter R Gibson, Department of Gastroenterology, Alfred Health and Monash University, Victoria 3004, Australia
Author contributions: Vasudevan A and van Langenberg DR were involved in the conception of the review, acquisition of data and analysis, drafting the article and final approval of the version to be submitted; Gibson PR was involved in drafting and the critical appraisal of the article.
Conflict-of-interest statement: Vasudevan A has no conflict of interest to declare; Gibson PR has served as consultant or advisory board member for AbbVie, Ferring, Janssen, Merck, Nestle Health Science, Danone, Allergan, Pfizer, Celgene and Takeda. His institution has received speaking honoraria from AbbVie, Janssen, Ferring, Takeda, Fresenius Kabi, Mylan and Pfizer. He has received research grants for investigator-driven studies from AbbVie, Janssen, Falk Pharma, Danone and A2 Milk Company. His Department financially benefits from the sales of a digital application and booklets on the low FODMAP diet. He has published an educational/recipe book on diet. van Langenberg DR has served as a speaker and/or received travel support from Takeda, Ferring and Shire. He has consultancy agreements with Abbvie, Janssen and Pfizer. He received research funding grants for investigator-driven studies from Ferring, Shire and AbbVie.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Abhinav Vasudevan, B. Medicine, Gastroenterologist, Department of Gastroenterology and Hepatology, Eastern Health, Level 2, 5 Arnold Street, Box Hill Hospital, Box Hill, Victoria 3128, Australia. abhinav.vasudevan@monash.edu
Telephone: +61-3-90949555 Fax: +61-3-98999137
Received: June 2, 2017
Peer-review started: June 6, 2017
First decision: June 22, 2017
Revised: July 3, 2017
Accepted: August 15, 2017
Article in press: August 15, 2017
Published online: September 21, 2017
Processing time: 110 Days and 22.7 Hours
Abstract

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 patient-centered approach and ensure treatment is given an appropriate timeframe to achieve maximal benefit prior to cessation.

Keywords: Crohn’s disease; Clinical pharmacology; Ulcerative colitis; Thiopurines; Inflammatory bowel disease; Biologics; Nutrition

Core tip: There appears to be marked variation in time to clinical response for therapies used in inflammatory bowel disease which is further influenced by disease and patient related factors. The most rapid response can be expected with corticosteroids, calcineurin inhibitors, exclusive enteral nutrition, aminosalicylates and anti-tumor necrosis factor therapy (within 2 mo), while methotrexate, thiopurines and vedolizumab can take several months to achieve maximal response. There is a lack of reporting of the time to response of therapies in clinical trials for inflammatory bowel disease and this remains an area that should be addressed in future studies.