IBD 2020: Right therapy, right patient, right time – Choosing wisely: Conclusions

This supplement contains a summary of presentations from the IBD 2020: Right Therapy, Patient, Time – Choosing Wisely virtual conference. On behalf steering committee I thank presenters and authors for their contributions. A consistent message throughout summaries is importance tailoring treatment to meeting patient's immediate long-term needs, underscoring meetings such as this share professional knowledge. The role targets principles monitoring these were discussed in Session One. care patients with inflammatory bowel disease (IBD) must not only address acute stages but, more importantly, look strategies which management. While symptoms can be transient over course lifetime, resultant damage digestive system cumulative. To ensure minimized clinicians aim achieve both prompt clinical response then prolonged deep remission including endoscopic healing, normalization biomarkers imaging, potentially histopathology; who goals have improved outcomes time. In setting Crohn's (CD), subclinical inflammation important. use fecal calprotectin Australia well established, polling attendees found 60% would regularly CD. retrospective study CD (N = 918) that routine using identify at risk progression, independently or location.1 tight strategies, biomarkers, comparison standard management discussed. been shown result benefit when compared management,2 they require motivated are prepared participate increased escalation, de-escalation, medical therapy. Other available clinician include therapeutic drug (TDM). PANTS (NCT03088449) lower concentrations week 14 associated higher rates anti-TNF failure3 TDM tool increase individualization patients. Speakers noted one mechanism status inform decisions combined other strategies. future will likely an telemedicine, remote (home testing capsule endoscopy), genetic immunological personalization techniques, artificial intelligence. By drawing on real world data and/or trial population level data, comparative effectiveness research (CER) improve our understanding most appropriate treatments patient, although caution needed interpreting results. propensity score matching lead small patient numbers, highly selected populations (clinical trials) non-randomized cohorts may adversely affect Further, changes algorithms assumptions used inconsistent results between analyses. ulcerative colitis (UC), similarity VICTORY consortium study4 VARSITY study5 suggests it possible similar registry head trial. Clinical prediction modeling tools applied provide indication respond treatment, probability (low, medium, high). place CER studies hypothesis generation clear, need head-to-head remains. absence definitive differentiating options IBD, continue base totality evidence varying design. Head-to-head trials, safety specific scenarios all pre-recorded sessions. three, live debate international speakers proposition “Anti-TNFs outdated, It's time move on” was supported by attendees. Pre-polling post-polling approximately 20% agreed deliberately contentious title, confirming Australian practice. argument away compelling, remains stronger, while acknowledging binary generalization simplified individualized. Anti-TNF therapies important regimens efficacious broad range indications. Significant amounts therapies, pregnancy. presence extraintestinal manifestations, infection risk, availability TDM, cost (due biosimilars) influence clinician's decision therapies. Concerns regarding during final session, Catastrophe prevention IBD: mitigation. presentation focused risks under-treatment over-treatment IBD. Establishing balance requires continued review, acknowledgement patients' needs concerns. complications resulting flares, hospitalizations failure, unnecessary risks. Both impact healthcare costs resource utilization. development models assist assessment likelihood highlighted.6-9 These accommodate multiple variables produce projections responding treatments, achieving remission, developing complications. decision-support individual treatment. Finally, discussions about choice shared decision-making consultations. Avoiding common mistakes corticosteroid managing severe colitis, wishes travel explored further Dr Miles Sparrow has received educational grants support Ferring, Orphan, Gilead; speaker's fees Janssen, AbbVie, Takeda, Pfizer, Shire; attended advisory boards Celgene, MSD, Emerge Health. Funded through unrestricted grant Takeda Pharmaceuticals Pty Ltd.