ECCO IBD Curriculum
16.2. Knows the evidence that supports the use of currently unlicensed therapies in IBD
This course is designed for gastroenterologists, surgeons, paediatricians, pathologists and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD). One major aim of this e-learning activity is to increase competence and knowledge with regard to the prediction, diagnosis and management of stricturing Crohn's Disease (CD) patients and to harmonise diagnostics and treatment in order to improve patient outcomes.
Upon completion of this activity learners will:
- Achieve familiarity with predictors of fibrostenosing CD.
- Understand the role of cross-sectional imaging in the diagnostic work-up of patients with suspected fibrostenosing CD.
- Understand the current management of fibrostenosing CD.
- Recognise the therapeutic capabilities of anti-inflammatory therapy, endoscopic dilatation and surgery in the setting of fibrostenosing CD.
Two new drugs have recently been approved by the European Medical Agency and one additional strategy will soon follow. With regard to the first part, this includes Filgotinib, an addition to the Janus Kinase inhibitor class with a higher specificity to Jak1. Furthermore, an entire new class has entered the field of IBD by the introduction of Ozanimod the first S1P receptor modulator. Last, anti-IL-23 antibodies are expected to be approved soon. The data of the clinical studies will be shortly summarized and all three drugs will be placed in our current treatment algorithm by discussing efficacy, side-effects as well as the role with regard to extraintestinal manifestations.
1. To understand the mode of action of the three drugs described
2. To review the clinical trials that resulted in the approval of these drugs.
3. To know potential side-effects and required strategies.
4. Identify a possible role within the treatment algorithm.
- Role and efficacy of Fecal microbiota transplantation in IBD
- Role and efficacy of new nutritional intervention in IBD
1. To review recent epidemiologic data, highlighting the importance of environmental factors
2. To understand the complexity and multiple factors contributing to IBD pathogenesis
3. To acknowledge how the complexity of IBD may affect treatment effects
1. Learn about the mechanisms of action of tofacitinib
2. Understand the clinical and endoscopic efficacy of tofacitinib in UC
3. Discuss the safety profile of tofacitinib
Numerous small molecules and biologics are being tested in phase 1-3 trials. Regarding JAK inihibitors, we still do not know whether JAK selectivity is associated with an improved risk-benefit profile, especially regading zoster risk. TYK2, gut selective or not, look promising and also showed very encouraging results in psoriasis. Other small molecules targeting integrins or PDE4 may be approbed in a near future. Regarding biologics and beyond biosimilars, many compounds are being developed such as Abivax. One question remains after 2 decades of biologics development : who will beat infliximab? Combination of biologics and bispecific antibodies might tackle this issue. Pending these molecules, many head to head trials are ongoing.
1) Description of immune pathways that drive inflammation in IBD
2) Discussion of the pathways targeted by current and future therapies
3) review of clinical evidence supporting use of novel therapies (selective Jaki, Sphingosine modulators, anti p19 therapies)
4) Highlight the data on adverse effects of new therapies
5) Stem cell therapies for perianal fistulae
6) Discuss novel formulations of existing agents (low systemic bioavailable steroids)