P1167 Treatable traits (TTs) approach in the management of Inflammatory Bowel Disease: a new concept

Abstract Background Inflammatory bowel diseases (IBD) are highly prevalent and complex chronic conditions that affect the digestive tract and induce extra-intestinal manifestations and numerous comorbidities. Distinct IBD phenotypes and clinical manifestations differ individually1. The pathogenesis of the disease is complex and requires personalized therapies2. The World Health Organization (WHO) recommends a holistic approach that is defined as "perfect physical, mental and social well-being." “Treatable traits" (TT) is a personalized and multidimensional precision medicine approach created primarily to deal with the complexity and heterogeneity of chronic and complex conditions. Initially proposed for treating respiratory diseases, it has expanded to other areas3. The present abstract aims to shed light on, identify, and define the most prevalent TTs applied to IBD. Methods TTs were identified according to their clinical relevance and the possibility of being modifiable, enabling personalized and individualized treatment targeting. They were subdivided into three main domains following the concept of TT in IBD. Adopting the TT concept will be useful in primary health care and tertiary centers to aim for disease control, avoiding exacerbations, and maximizing results, as demonstrated in other diseases4. Results Gastrointestinal or intrinsic TTs are composed of laboratory investigations (biomarkers), endoscopic and radiological, to identify the phenotypic characteristics and the degree of inflammatory activity. Extra-intestinal TT: The main ones are rheumatological, dermatological, ophthalmological, and hematological. It is important to emphasize that many of these extra-intestinal manifestations appear as comorbidities. Psychological and behavioral TT: based on the patient's lifestyle and behavior and include obesity and malnutrition, diet and nutrients, smoking, sedentary lifestyle and physical activity, sleep quality, fatigue, adherence to treatment, and family support network) as well as the mental health including anxiety, depression, and suicidal ideation. The list of treatable characteristics is limited by the knowledge of the interactions identified to date and will expand as they are identified and targeted treatments approved by ECCO. Conclusion The definition and identification of TT in IBD are feasible and reported for the first time. Treatment based not only on pharmacological treatment aimed at mucosal healing and improves to address the limitations of existing treatment strategies to date. The holistic approach proposed by the authors will benefit not only in improving patients' QoL but also in providing a more effective, sustained, and long-lasting response. References 1.Le Berre C, Ananthakrishnan AN, Danese S, Singh S, Peyrin-Biroulet L. Ulcerative Colitis and Crohn’s Disease Have Similar Burden and Goals for Treatment. Clin Gastroenterol Hepatol. 2020 Jan;18(1):14-23. doi: 10.1016/j.cgh.2019.07.005. Epub 2019 Jul 10. PMID: 31301452. 2.Turner D, Ricciuto A, Lewis A, D'Amico F, Dhaliwal J, Griffiths AM, Bettenworth D, Sandborn WJ, Sands BE, Reinisch W, Schölmerich J, Bemelman W, Danese S, Mary JY, Rubin D, Colombel JF, Peyrin-Biroulet L, Dotan I, Abreu MT, Dignass A; International Organization for the Study of IBD. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021 Apr;160(5):1570-1583. doi: 10.1053/j.gastro.2020.12.031. Epub 2021 Feb 19. PMID: 33359090. 3.Agusti A, Gibson PG, McDonald VM. Treatable Traits in Airway Disease: From Theory to Practice. J Allergy Clin Immunol Pract. 2023 Mar;11(3):713-723. doi: 10.1016/j.jaip.2023.01.011. Epub 2023 Feb 1. PMID: 36737342. 4.Amati F, Bongiovanni G, Tonutti A, Motta F, Stainer A, Mangiameli G, Aliberti S, Selmi C, De Santis M. Treatable Traits in Systemic Sclerosis. Clin Rev Allergy Immunol. 2023 Oct;65(2):251-276. doi: 10.1007/s12016-023-08969-x. Epub 2023 Aug 21. PMID: 37603199.