There were anniversaries galore the ECCO Annual Congress in Dublin, Ireland. 

There were events to mark the 10th anniversary of ECCO’s inauguration, presentations showing five years of biologic treatment in ulcerative colitis, and a review of 10 years of biologics use in Crohn’s disease* 

* It’s actually been just over 11 years but that ruined the symmetry!  

What was learned amid all the balloons and cake? 

It seems that biologic treatment strategies are beginning to mature. In Crohn’s disease, there is the recognition that while conventional ‘step up’ approaches still dominate, there are strong factors shifting treatment practice towards the earlier use of biologics. 

Chief among these driving factors has been the ascendency of mucosal healing as a primary treatment goal; doctors are now focusing increasingly on the ability to achieve ‘deep remission’ through complete healing of the mucosa. Additionally, evidence is growing that anti-TNF therapies may have the capability to alter the natural course of the disease by inducing this deep remission, and doctors are excitedly waiting for the evidence base to grow over the coming years.

In the meantime, the emergence of tailored therapy regimens became a hot topic. The measurement of biologic drug trough and antibody levels, C-reactive protein (CRP) parameters, thiopurine metabolite ranges, and regular endoscopic monitoring look set to dictate the stages at which biologic therapies are introduced and the use of these tools to proactively manage patients will mark the beginning of tailored therapies for individual patients. 

In ulcerative colitis, two sets of data were presented that have the potential to shift the treatment algorithm considerably. 

In the first, data was presented from the SUCCESS trial studying the use of infliximab, azathioprine, and infliximab + azathioprine combination in moderate-to-severe ulcerative colitis. The data showed infliximab + azathioprine combination to be significantly superior to both monotherapy arms in inducing steroid-free remission, and patients treated with infliximab – either alone or in combination – were also more likely to achieve response and mucosal healing than with just azathioprine.

In the second presentation, data from a trial studying the use of ciclosporin vs. infliximab in severe refractory ulcerative colitis was discussed. The data showed infliximab to be non-inferior to ciclosporin with similar response rates and time to colectomy observed for both groups and overall safety was better in the infliximab arm. The consensus view was that infliximab should now be considered the standard treatment for severe refractory ulcerative colitis.