Identification of Endpoints for Development of Antifibrosis Drugs for Treatment of Crohn's Disease

Gastroenterology. 2018 Jul;155(1):76-87. doi: 10.1053/j.gastro.2018.03.032. Epub 2018 Mar 28.


Background & aims: Intestinal fibrosis is a challenge to management of patients with Crohn's disease (CD); there is an urgent need to expedite development of antifibrosis drugs for this disease. The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) aimed to identify a set of endpoints that can be used to determine efficacy of antifibrosis agents tested in clinical trials of patients with CD.

Methods: We conducted a systematic review to identify clinical, radiologic, biochemical, endoscopic, and composite endpoints used in assessing activity of fibrostenosing CD and response to treatment, and determined their operational properties. A panel of IOIBD experts performed a consensus process to identify the best endpoints for inclusion in clinical trials, through a 2-round, Delphi-style online survey.

Results: A total of 36 potentially relevant endpoints for intestinal fibrosis were selected and assessed. Forty-eight physicians with expertise in inflammatory bowel disease, from 5 regions (North America, Europe, Middle East, Asia/Pacific, and Latin America), participated in the Delphi consensus process. A core set of 13 endpoints (complete clinical response, long-term efficacy, sustained clinical benefit, treatment failure, radiological remission, normal quality of life, clinical remission without steroids, therapeutic failure, deep remission, complete absence of occlusive symptoms, symptom-free survival, bowel damage progression, and no disability) were rated as critical. Agreement was high among the experts.

Conclusions: Members of the IOIBD reached expert consensus on a set of endpoints that can be used to assess antifibrosis agents in trials of patients with CD. Studies are needed to clarify methods for measuring these outcomes and validate measurement instruments.

Keywords: Biomarker; Fibrotic; IBD; IOIBD.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Constriction, Pathologic
  • Crohn Disease / diagnostic imaging
  • Crohn Disease / drug therapy*
  • Crohn Disease / pathology
  • Crohn Disease / physiopathology
  • Delphi Technique
  • Endoscopy, Digestive System
  • Fibrosis
  • Humans
  • Intestines / diagnostic imaging
  • Intestines / pathology*
  • Intestines / physiopathology
  • Outcome Assessment, Health Care