Treat the patient or treat the disease?

Our therapeutic goals for the treatment of ulcerative colitis and Crohn's disease are evolving. Until the last decade the goals were primarily the treatment of symptoms. Regulatory approval for ulcerative colitis therapies have been based on short-term improvements in clinical indices and, most recently, the ability to heal the colonic mucosa, whereas approval for Crohn's disease therapies have been based on reductions in the CDAI (Crohn's Disease Activity Index). Over the past decade there has been increasing evidence in favor of more 'objective' measures of biologic disease activity including biomarkers such as C-reactive protein and mucosal healing in Crohn's disease and the histologic resolution of active inflammation in ulcerative colitis. The objective changes have provided expanded therapeutic goals based on longer-term maintenance therapies with the potential to modify the chronic disease behavior and to reduce pharmacoeconomic costs (reductions in hospitalizations, surgeries and neoplasia).