Biological Treatment of Crohn’s Disease

Abstract

Introduction of biological agents for the treatment of Crohn’s disease (CD) has led to a transformation of the treatment paradigm. Several biological compounds have been approved for patients with CD refractory to conventional treatment: infliximab, adalimumab and certolizumab pegol (and natalizumab in several countries outside the European Union). However, despite the use of biologics for more than a decade, questions still remain about the true efficacy and the best treatment regimens – especially about when to discontinue treatment. Furthermore, a need for optimizing treatment with biologics still exists, as 20–40% of patients with CD (depending on selection criteria) do not have any relevant response to the current biological agents (i.e. primary failures). A better patient selection might maximize the clinical outcome while minimizing the complications associated with this type of therapy. However, the clinical tools capable of identifying such patients are still unavailable, and the trough level strategy may help the clinician to optimize therapy and to avoid loss of response and/or immunogenicity (i.e. a low but measurable antibody level exists just before the periodic administration of the biological agent). On the other hand, peak levels and average levels should not exceed concentrations associated with increased toxicity. Randomized, controlled studies focusing on trough levels and antibodies towards the biological agent in routine clinical situations may add important pieces to the puzzle for a more rational treatment algorithm of CD patients. In some situations, the risks (i.e. immunogenicity, serious infections and the promotion of neoplasia) may, however, not outweigh the benefits of biological treatment.

Long‐term efficacy and safety of ustekinumab for Crohn's disease through the second year of therapy

“…Long‐term efficacy has been demonstrated with azathioprine/mercaptopurine, methotrexate, tumour necrosis factor (TNF) antagonists, natalizumab, and vedolizumab . Although TNF antagonists have significantly advanced the care of Crohn's disease, their efficacy is limited and the development of anti‐drug antibodies is associated with loss of response . In addition, potential significant side effects of maintenance treatments include bone marrow suppression, malignancy, and serious infections .…”

Entero‐Behçet's disease coexisting with long‐term epilepsy and schizophrenia‐like symptoms

“…The therapy for idiopathic colitis has been transformed with the introduction of anti‐TNF treatment . Introduction of biological agents for the treatment of Crohn's disease (CD) has led to a transformation of the treatment paradigm . The therapy for ulcerative colitis and CD has been transformed with the introduction of anti‐TNF treatment .…”

Surgical Treatment of Complex Small Bowel Crohn Disease

“…[68][69][70] Moreover, newer guidelines have advocated for a treatment goal of mucosal healing and "deep remission," resulting in more aggressive and extensive medical therapy even for patients with clinical remission. [68][69][70] Moreover, newer guidelines have advocated for a treatment goal of mucosal healing and "deep remission," resulting in more aggressive and extensive medical therapy even for patients with clinical remission.…”