Remission for IBD is defined as the stopping of bleeding and normalization of bowel movements. Historically, IBD management utilized a step-up approach with new drugs being added when a patient failed the initial treatment or needed add-on therapy. This symptomatic approach was not aimed at the deeper pathophysiological mechanisms of the disease and thus lacked improvement of long-term disease outcomes.
The current treatment paradigm is based on the idea of combining risk stratifications. This method helps identify patients who may have a more aggressive disease and pushes for earlier intervention, with the expectation that the shorter the disease duration, the higher the likelihood that patients will enter remission and have fewer complications. The overall strategy is to “treat deeper” (focused on achieving deep mucosal healing, particularly in CD) and “treat to target” (focused on achieving disease remission by adjusting therapy according to the achievement of predefined treatment response targets).
Treatment of mild to moderate IBD still follows a traditional step-up approach and is typically started with aminosalicylates, which are more effective in UC than CD treatment (for which efficacy data is limited).