New research, however, could shine some light on a murky area for healthcare professionals.
A research team from Massachusetts General Hospital (MGH), the Broad Institute of MIT, and Harvard University, published their last month in the peer-reviewed scientific journal Cell Host & Microbe.
The focus of the research was an analysis of the gut microbiome — the community of tiny microorganisms that live inside the digestive tract.
Researchers concluded there were commonalities in the microbiomes of people with IBD for whom antibody-based drug treatments were successful, and for people who didn’t respond to the treatment.
The findings showed that doctors may be able to predict the efficacy of treatments for IBD before they’re even prescribed, all on the basis of analyzing the microbial population of the patient’s gut.
Difficulties of the disease
IBDs like Crohn’s and ulcerative colitis are chronic and can’t be cured, but a range of treatments is available to help manage the symptoms.
“Many people think that IBD is multifactory, meaning we don’t know exactly what causes it, which means the treatment cannot cure IBD, only treat it,” Cheng Zhang, MBBS, of The Ohio State University Wexner Medical Center, told Healthline.
Options available to people with IBD include surgery, such as bowel resection or colostomy, as well as various anti-inflammatory and immunosuppressive drugs and steroids.
Further options include vitamin supplements, changes to the diet, and alternative medicines.
There are also biologics. These drugs are useful for targeting specific parts of the immune response, but it’s often difficult for doctors to know which parts to focus on.
“I think that right now, more and more people talk about personalized medicine, but we still have a long way to go,” said Zhang.
“Currently, the therapy for IBD is still not optimized, even though there are different medications,” Zhang added. “The success rate is still not as good as we’d like — probably only 45 to 55 percent have achieved remission on their current medications. Efficacy for medications is still not optimized yet.”
“We are currently limited in our ability to predict which patients will respond to which therapies,” said lead author Ashwin Ananthakrishnan, MBBS, of the MGH Division of Gastroenterology, in a press release. “Our finding that the pre-treatment composition and function of intestinal bacteria could predict treatment response offers a novel additional tool for personalized therapy choice.”
Building on prior research
Recent research has found that gut microorganisms play a role in various immune system disorders, so Ananthakrishnan’s team set out to find out if the gut microbiome could predict which patients would respond to specific therapies.
Researchers studied 85 people with IBD (43 had ulcerative colitis, and 42 had Crohn’s disease).
The patients were all given vedolizumab, a biologic therapy. Stool samples were taken from each participant before and after treatment, allowing researchers to study the composition and function of each patient’s gut microbiome.
After analysis, it was found that patients who had more diverse microbial populations prior to treatment were more likely to meet the criteria for remission of IBD symptoms after 14 weeks.
A diverse gut microbiome means there’s a greater likelihood of potentially anti-inflammatory microorganisms.
The microbial changes observed after 14 weeks in patients who achieved remission persisted for at least a year, meaning these early changes can help predict who will respond positively, and maintain that response.
Costs are a barrier
“I think this research is very interesting, very new, but we need more studies to test the findings,” Zhang told Healthline.
The cost of microbiome sequencing and analysis is currently too high to make it practical for routine screenings, but Ananthakrishnan says his team hopes to build on their promising findings.
“The ability to pick the treatment most likely to work for a patient would be enormously helpful both in helping achieve remission quickly and in avoiding exposures to drugs that would be unlikely to work, may be costly, and may have adverse side effects,” said Ananthakrishnan in a press release.
“In addition to testing this approach in larger groups of patients and with different drugs to see if it can reveal comparative effectiveness, we hope to use this data to develop targeted probiotics that may be able to adjust the population in those with an unfavorable baseline microbiome.”