Dr Kinnucan reviews her presentation to advanced practice professionals at the Crohn's & Colitis Congress on implementing a treat to target strategy for patients with inflammatory bowel disease.

Jami Kinnucan, MD, is a senior associate consultant at the Mayo Clinic in Jacksonville, Florida.

TRANSCRIPT

I am Jami Kinnucan. I'm a senior associate consultant at the Mayo Clinic, Florida, and I'm here at Crohn's and Colitis Congress 2023. I had the pleasure of speaking to a room full of advanced practice providers yesterday about the importance of implementing a treat to target strategy in their approach to managing patients with ulcerative colitis and Crohn's disease.

I first highlighted the importance of really early recognition of symptoms and diagnosis in patients with inflammatory bowel disease, as we know that delays in diagnosis can lead to worse outcomes for patients. In addition, once a patient has a diagnosis of ulcerative colitis or Crohn's disease, it's really important to risk stratify that patient to a) understand how severe their disease is currently at presentation, but also what is their prognosis in the next 3 to 5 years, lifetime of their disease. And we do have some clinical tools, as well as some objective tools, that we can implement in patients when we're evaluating what their prognosis of their disease is.

Once you identify that person and that patient in front of you, what their risk is, it's really now working with the patient in an individualized plan with shared decision-making about finding the right treatment for their disease. After you start that treatment is really where we employ the treat to target strategy.

So the understanding of the use of biomarkers, which my colleague, Dr. Ben Cohen from Cleveland Clinic, did an excellent presentation, really outlining a lot of the biomarkers that we're using, things like C-reactive protein, remembering that almost 20% of our population does not make C-reactive protein, despite having active inflammation; fecal calprotectin, which can be used in both ulcerative colitis and Crohn's disease. But really the importance in what was stressed during the discussions yesterday was getting that baseline evaluation and benchmarking that to something like a CT enterography, MR enterography in Crohn's disease patients, and colonoscopy in both ulcerative colitis and Crohn's disease patients, so that you know what targets you're going to be following moving forward.

So often in my practice, when I have a patient who I initiate on a therapy, we decide, usually within the first 4 to 8 weeks, when we're going to check back in, both clinically how they're doing, as well as how we're going to objectively measure whether their inflammation is actually getting better. We know that sometimes symptoms can persist, despite the fact that inflammation is improving. So I think the take homes that we really stressed in our discussions yesterday were the importance of a) getting baseline assessment, b) selecting the right treatment for that patient using shared decision-making, and then c) having a follow-up plan, usually within the first 4 to 8 weeks after initiation of therapy, both to check in with their clinical symptoms, if their quality of life is improving, and then using objective markers to assess how well disease inflammation is improving, as well.

Thank you so much.