Biologic therapies for chronic inflammatory bowel disease

Abstract

Crohn's disease (CD) and ulcerative colitis (UC) make up the so-called chronic inflammatory bowel disease (IBD). Advances in the understanding of IBD pathophysiologic mechanisms in the last few years have allowed the development of novel therapies such as biologic therapies, which at least theoretically represent a more specific management of this disease with fewer side effects. Currently, the only effective and widely accepted biologic therapy for the treatment of intraluminal, fistulizing CD, both for remission induction and maintenance, is infliximab. The role of other monoclonal antibodies such as adalimumab is not clearly established. It could be deemed an alternative for patients with allergic reactions to infliximab, and for those with lost response because of anti-infliximab antibody development. However, relevant issues such as dosage and administration regimen remain to be established. Antiintegrin α4 therapies, despite encouraging results in phase-3 studies, are still unavailable, as their marketing authorization was held back in view of a number of reports regarding progressive multifocal leukoencephalopathy cases. Immunostimulating therapy may be highly relevant in the near future, as it represents a novel strategy against disease with the inclusion of granulocyte-monocyte colony-stimulating factors.Regarding ulcerative colitis, results from the ACT-1 and ACT-2 studies showed that infliximab is also useful for the management of serious UC flare-ups not responding to standard treatment, which will lead to a revision of therapeutic algorithms, where this drug should be given preference before intravenous cyclosporine. In the next few years, the role of anti-CD3 drugs (vilisilizumab), T-cell inhibiting therapies, and epithelial repair and healing stimulating factors will be established.Key words: Inflammatory bowel disease. Crohn's disease. Ulcerative colitis. Therapy. 2006; 98: 265-291. Martínez-Montiel MP, Muñoz-Yagüe MT. Biologic therapies for chronic inflammatory bowel disease. Rev Esp Enferm Dig INTRODUCTIONCrohn's disease (CD) and ulcerative colitis (UC) make up the so-called inflammatory bowel disease (IBD). Advances in the knowledge of this condition's etiopathogenesis have been correlated to the development of novel therapeutic agents. Medical treatment is currently the cornerstone for managing these conditions, and surgery is reserved for complications or treatment refractoriness (1). The available therapeutic armamentarium includes anti-inflammatory drugs (aminosalicylates and steroids), antibiotics, and immune modulators (azathioprine, 6-mercaptopurin, cyclosporin and methotrexate). All these drugs result in a nonspecific suppression of inflammatory processes, and their use during the past few years has determined a relevant advance in BDI control. However, their efficacy is limited and they are not exempt from side effects. Biologic therapies, at least theoretically, would be more therapeutically effective with fewer side effects, and thus would represent more specific means for t...

Effects of Thyme Extract Oils (fromThymus vulgaris,Thymus zygis,andThymus hyemalis) on Cytokine Production and Gene Expression of oxLDL-Stimulated THP-1-Macrophages

“…Nowadays medicinal therapies for CIBDs involve treatment with nonsteroidal anti-inflammatory drugs, antibiotics, corticosteroids, and immunosuppressant, but the application of these drugs is limited due to their toxicity and side effects [24]. Therefore, there is an increasing interest in finding alternative treatments with fewer side effects.…”

Integrin involvement in freeze resistance of androgen-insensitive prostate cancer

“…Reports by our group 58–60 and Le Pivert 61 have detailed the advantages of using neo-adjunctive, low-dose chemotherapeutic agents to weaken prostate tumors prior to cryosurgery, which has shown to be effective beyond that of either treatment alone. Thus, it may be possible to adjust extant integrin targeting treatments 62 to inhibit α6β4 integrin, which may be overexpressed in prostate cancer, and combine that therapy with cryotherapy to achieve reduced prostate cancer disease recurrence and increase patient quality of life.…”

Stem cell therapy in inflammatory bowel disease: A promising therapeutic strategy?

“…Its etiology is unknown, but it is accepted that it could be the result of loss of tolerance to intraluminal bowel antigens [1] . Genetic, environmental, and microbiological factors are involved in its development, Stem cell therapy in inflammatory bowel disease: A promising therapeutic strategy?…”

“…Its etiology is unknown, but it is accepted that it could be the result of loss of tolerance to intraluminal bowel antigens [1] . Genetic, environmental, and microbiological factors are involved in its development, together with morphological and functional changes in the intestinal barrier associated to an impaired immune response [2] .…”