“My name is Hope, and I’ll be your nurse today. Can you please tell me your full name?”
These were the words of the nurse. Hope, as she prepared to administer the biological treatment through her vein. A fleeting smile crossed her face, in an attempt to distract the nurse from the tear rolling down her cheek.
She remembered her doctor’s words the moment she told him she no longer wanted to receive this treatment. His words echoed in her mind, “This is the last bullet, don’t waste it!”
Over the past seven years, she had tried various treatments, from the least to the most effective. These treatments had initially brought relief and improved her quality of life, but their effectiveness had diminished over time.
Today, she clung to a glimmer of hope, as her doctor had told her, “Don’t worry. I will prescribe the treatment for you to take every four weeks instead of eight. If this treatment fails, we will look for a new hope because science is still evolving and we must find what suits you best.”
Reluctantly, she agreed, knowing the discomfort of the small, dimly lit treatment room enveloped in darkness by heavy curtains.
The cold air biting through her thin hospital gown.
The hours that would stretch ahead, separating her from the warmth and laughter of her beloved children.
And then there were the side effects-dizziness and nausea-that accompanied each session, a harsh reminder of the battle she tights within.
Interrupting her thoughts, Hope softly asked, “Are you ready?” With a nod, she whispered a prayer, seeking mercy and healing
Recent studies reveal that:
- 1/3 of patients are primary non-responders to treatment.
- 1/2 of patients lose their response to treatment over time.
Despite the availability of numerous treatment options, none can be considered a “magic bullet” as success rates in IBD therapy still fall short of expectations.
For instance, when evaluating remission rates, which assess clinical improvement based on stool frequency, blood loss, and endoscopy results (using the Mayo score), there is a celling of only 20- 30% in induction trials.
However, does this mean the advancement of IBD treatment has reached its limit?
References:
- Alsoud D, Verstockt B, Fiocchi C, Vermeire S. Breaking the therapeutic ceiling in drug development in ulcerative colitis. Lancet Gastroenterol Hepatol. 2021 Jul; 6(7):589-595.
- Ford A et al. Efficacy of biological therapies in inflammatory bowel disease: Systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):644-59.
- Jagirdhar GSK, Perez JA, Perez AB, Surani S. Integration and implementation of precision medicine in the multifaceted inflammatory bowel disease. World J Gastroenterol. 2023 Sep 28;29(36):5211- 5225.
- Magro F, Moreira PL, et al. Has the therapeutical ceiling been reached in Crohn’s disease randomized controlled trials? A systematic review and meta-analysis. United European Gastroenterol J. 2023 Mar; 11(2):202-217.
- Mao R, Chen M. Precision medicine in IBD: genes, drugs, bugs and omics. Nat Rev Gastroenterol Hepatol. 2022 Feb; 19(2):81-82.
