Simon Travis: Clinical Trials in Gastroenterology

Q: Why do you conduct clinical trials in inflammatory bowel disease?

ST: Inflammatory bowel disease is about Crohn's and ulcerative colitis. It's about bringing tomorrow's treatment to patients today. It's about translating science into clinical practice, and for me at the John Radcliffe it's about bringing the cutting edge care to our patients in the clinic.

Q: Do those clinical trials show promising results?

ST: Certainly. There have been a host of new monoclonal antibodies which are effective for treating diseases which would otherwise be medically untreatable. But there are also studies which are looking at the strategy and approaches to treatment which will alter the pattern of disease in the long term and that's our goal.

Q: Can you give us an example?

ST: There's a very good one which is called the CALM study which we're contributing to in Oxford. This is looking at conventional stepped care with a monoclonal antibody called adalimumab. It is examining tight disease control against conventional clinical symptom disease control. The outcome in two years will, I hope, show a reduction in hospitalisation, surgery, and improved quality of life for patients.

Q: What are the most important lines of research that have developed over the past 5 or 10 years?

ST: I think they are two-fold. The first is the individual targets of treatment. There's a host of cell-signalling molecules which we now have antibodies against, or can use to deliver treatment, so individual targets is one component. But we're not going to change the pattern of chronic life-long disease like ulcerative colitis or Crohn's disease with those sorts of treatments. I think we need therefore a set of strategy studies that can be used to look at all aspects of patient care. In a chronic disease you need this specific timing of treatment so you know where drugs play in the therapeutic armamentarium.

Q: Why does your line of research matter, why should we put money into it?

ST: Inflammatory bowel disease, Cronh's and ulcerative colitis are the epidemics of the future. Around 1% of people in the UK and in Europe have IBD. It's expanding in East Asia, in South America and in the Gulf; if 1% of the population in those countries get IBD then we have a health problem and that's why it matters.

Q: How does your research fit into translational medicine within the department?

ST: In many ways. We've integrated the basic science and the clinical practice at the John Radcliffe which is a really exciting area for gastroenterology. Inflammation underpins carcinogenesis; it interacts with the delivery of care and the new models for delivering care. But also from an NDM perspective with an international component, then part of my role as president of the European Crohn's and Colitis Association representing 31 countries in Europe; also interacting with China, Japan, Korea who've just formed the Asian organisation of Crohn's and Colitis. NDM have an active program in the Far East and also in South America and in the Gulf states and that will bring research fellows and give a profile for Oxford Gastroenterology abroad.