Biologic agents for IBD: practical insights

Abstract

Six biologic agents are currently approved for the treatment of IBD: four anti-TNF agents (infliximab, adalimumab, golimumab and certolizumab pegol) and two anti-integrin agents (natalizumab and vedolizumab). In Crohn's disease and ulcerative colitis refractory to standard medications, treatment choice among available biologic agents can be challenging. Several parameters should be taken into account to help physicians through the decision-making process, including the comparative effectiveness and long-term safety profile, availability and labelling in the prescriber's country, international guidelines, and cost, as well as patient preferences (such as the route of administration). Herein, we provide practical insights on the use of biologic agents in IBD. The results of head-to-head trials between biologic agents are eagerly awaited to guide decision-making regarding the choice of first-line biologic agents and to determine whether switching within the same drug class or swapping (switching out of the drug class) is preferable after primary or secondary loss of response to the first biologic agent. In the near future, treatment algorithms might evolve with the launch of new drugs (such as ustekinumab, tofacitinib and etrolizumab) and the increased use of biosimilars.

Update zu chronisch entzündlichen Darmerkrankungen

“…Zudem laufen derzeit vielversprechende Phase-II-Studien, die über unterschiedliche Wirkmechanismen agieren. Dazu gehö-ren der Januskinase-Inhibitor Tofacitinib (vor allem wirksam bei CU), der monoklonale Anti-p19-Antikörper Medi2070, der Sphingosine-1-Phosphat-RezeptorModulator Ozanimod, der monoklonale MAdCAM-Antikörper PF-00547659 und der monoklonale β7-Integrin-Antikörper Etrolizumab [28].…”

Clinical development of biologicals and biosimilars - safety concerns

“…For the management of inflammatory bowel disease, six innovator biological medicines are currently available across the world: four antitumor necrosis factor agents (adalimumab, certolizumab pegol, golimumab, and infliximab) and two antiintegrin molecules (natalizumab and vedolizumab) [7]. No clinical trials involving these biosimilars have been conducted in inflammatory bowel disease; marketing authorizations have been granted though the extrapolation of data from other indications [8].…”

Emerging biologics in inflammatory bowel disease

“…These novel targets include, but are not limited to, oral Janus kinase (JAK) inhibitor (tofacitinib), interleukin inhibitor (ustekinumab), oral SMAD7 antisense oligonucleotide (mongersen), and anti-integrin inhibitors (vedolizumab) [36].…”