Na Soo Young, Moon Won
Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
Korean J Gastroenterol. 2018 Feb 25;71(2):61-68. doi: 10.4166/kjg.2018.71.2.61.
It is important to have effective therapeutic strategies and goals in clinical practice and research of inflammatory bowel disease. Conventional end points for clinical trials in Crohn's disease and ulcerative colitis have been based on composite indices, such as the Crohn's Disease Activity Index and the Mayo Clinic Score. Although these indices have been shown to reduce the intestinal injury to some extent, satisfactory results have not been obtained in improving the quality of life of patients. Recently, alternative measures of outcome and definitions of response are being developed beyond symptoms. Mucosal healing as a clinical response and treatment goal has showed better long-term outcomes. Patient-reported outcomes (PROs) are emerging instrument directly created by patient to quantify symptoms. Coprimary realistic treatment 'target', comprising mucosal healing and PROs, can offer a clinically valid endpoint and can be readily applied in practice compare to existing composite indices. 'Treat-to-target' algorithm based on mucosal healing and PROs, in which therapy is progressively intensified until a specific personal treatment goal is reached, could improve quality of life of patient by reducing disease-related disability. Furthermore, histologic remission is an area of increased research focus and has the potential to guide treatment decisions in the future.
在炎症性肠病的临床实践和研究中，拥有有效的治疗策略和目标非常重要。克罗恩病和溃疡性结肠炎临床试验的传统终点一直基于综合指标，如克罗恩病活动指数和梅奥诊所评分。尽管这些指标已被证明在一定程度上可减轻肠道损伤，但在改善患者生活质量方面尚未取得令人满意的结果。最近，除症状之外，正在开发其他结局衡量指标和反应定义。黏膜愈合作为一种临床反应和治疗目标已显示出更好的长期结果。患者报告结局（PROs）是由患者直接创建的用于量化症状的新工具。包括黏膜愈合和患者报告结局的共同主要现实治疗“目标”，与现有的综合指标相比，可提供一个临床有效的终点且可在实践中轻松应用。基于黏膜愈合和患者报告结局的“达标治疗”算法，即逐步加强治疗直至达到特定的个人治疗目标，可通过减少与疾病相关的残疾来改善患者生活质量。此外，组织学缓解是一个研究关注度不断增加的领域，并且有可能在未来指导治疗决策。
