Beyond the Gut: The Importance of Controlling Systemic Inflammation in Inflammatory Bowel Disease

Summary of presentations from the AbbVie-Sponsored Symposium on Inflammatory Bowel Disease, held at the 11th Congress of the European Crohn’s and Colitis Organisation (ECCO) in Amsterdam, Netherlands, on 17th March 2016

Chairperson: Geert D’Haens1
Speakers: Yehuda Chowers,2 Remo Panaccione,3 Geert D’Haens1

1. Academic Medical Centre-IBD Unit, University of Amsterdam, Amsterdam, Netherlands
2. Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel
3. Inflammatory Bowel Disease Group, University of Calgary, Calgary, Canada

Disclosure: Yehuda Chowers has received consulting/lecture fees from AbbVie, Janssen, Takeda, and Protalix. Remo Panaccione is a consultant for AbbVie/Abbott, Amgen, Aptalis, AstraZeneca, Baxter, Bristol-Myers Squibb, Celgene, Cubist, Eisai, Ferring, Gilead, Janssen, Merck, Robarts, Salix, Samsung, Shire, Centocor, Elan, GlaxoSmithKline, UCB, Pfizer, and Takeda; has participated in speaker bureaux for Abbvie/Abbott, Aptalis, AstraZeneca, Ferring, Janssen, Merck, Prometheus, Shire, and Takeda; and advisory boards for AbbVie, Abbott, Amgen, Aptalis, AstraZeneca, Baxter, Eisai, Ferring, Genentech, Jansen, Merck, Schering-Plough, Shire, Centocor, Elan, GlaxoSmithKline, UCB, Pfizer, Bristol-Myers Squibb, Takeda, Cubist, Celgene, and Salix; and has received research/educational support from AbbVie/Abbott, Ferring, Janssen, and Takeda. Geert D’Haens is an advisor for AbbVie, Ablynx, Amakem, AM Pharma, Avaxia, Biogen, Bristol Meiers Squibb, Boerhinger Ingelheim, Celgene, Celltrion, Cosmo, Covidien, Ferring, DrFALK Pharma, Engene, Ferring, Galapagos, Gilead, GlaxoSmithKline, Hospira, Johnson and Johnson, Medimetrics, Millenium/Takeda, Mitsubishi Pharma, Merck Sharp Dome, Mundipharma, Novonordisk, Pfizer, Prometheus laboratories/Nestlé, Receptos, Robarts Clinical Trials, Salix, Sandoz, Setpoint, Shire, Teva, Tigenix, Tillotts, Topivert, Versant, and Vifor and received speaker fees from AbbVie, Ferring, Johnson and Johnson, Merck Sharp Dome, Mundipharma, Norgine, Pfizer, Shire, Millenium/Takeda, Tillotts, and Vifor; and has received speaker fees from Abbvie, Ferring, Jansen Biologics, Merck Sharp & Dohme, Mundipharma, Norgine, Shire, Takeda, Tillotts, UCB, and Vifor.
Acknowledgements: Writing assistance was provided by Jackie Phillipson, PhD, CMPP, at Ashfield Healthcare Communications Ltd.
Support: The publication of this article was funded by AbbVie. The views and opinions expressed are those of the speakers and not necessarily of AbbVie.
Citation: EMJ Gastroenterol. 2016;5[Suppl 7]:2-10

Meeting Summary

Inflammatory bowel disease (IBD) management goals have recently focussed on gastrointestinal symptom resolution and mucosal healing. IBD causes systemic disorder, with inflammation occuring both within and outside the gut, with associated morbidity, disability, and quality of life (QoL) impairment. Thus, there is a need to reduce the overall burden of chronic inflammation in IBD.

Environmental factors, genetics, gut microbiota, and the immune system significantly impact IBD and its extraintestinal manifestations (EIMs). T cells play a crucial role in immunity, and certain subsets are associated with several chronic inflammatory disorders, including IBD. Targeting such cells and/or key inflammatory cytokines (e.g. interleukins [IL], and tumour necrosis factor [TNF]) provides a basis for several IBD therapies.

Systemic inflammation in IBD can involve the development of fistulae and/or EIMs. Common EIMs include musculoskeletal pain, dermatological and ocular lesions, and primary sclerosing cholangitis (PSC). Early diagnosis of fistulae and EIMs should help guide IBD therapy and reduce overall morbidity. Many EIM treatment options are currently available with varying degrees of efficacy e.g. sulfasalazine, COX-2 inhibitors, certain antibiotics, immunomodulators, anti-TNFs, corticosteroids, and ursodeoxycholic acid. However, fistulae and most EIMs respond well to anti-TNFs, such as adalimumab and infliximab.

Prognostic markers aid disease treatment. C-reactive protein (CRP) is a valuable marker of systemic inflammation in IBD (particularly Crohn’s disease [CD]). Current anti-TNF agents (e.g. adalimumab) markedly reduce CRP levels in IBD and have a significant effect on IBD and various EIMs. Numerous novel agents for IBD are under development; examples include Janus kinase (JAK) inhibitors, IL inhibitors, SMAD-7 blockers, sphingosine 1-phosphate receptor 1 (S1P1) inhibitors, and anti-adhesion molecules.

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