Biological Treatments in Inflammatory Bowel Disease: A Complex Mix of Mechanisms and Actions

Abstract

Inflammatory bowel disease (IBD) is a chronic disease that requires lifelong medication and whose incidence is increasing over the world. There is currently no cure for IBD, and the current therapeutic objective is to control the inflammatory process. Approximately one third of treated patients do not respond to treatment and refractoriness to treatment is common. Therefore, pharmacological treatments, such as monoclonal antibodies, are urgently needed, and new treatment guidelines are regularly published. Due to the extremely important current role of biologics in the therapy of IBD, herein we have briefly reviewed the main biological treatments currently available. In addition, we have focused on the mechanisms of action of the most relevant groups of biological agents in IBD therapy, which are not completely clear but are undoubtfully important for understanding both their therapeutic efficacy and the adverse side effects they may have. Further studies are necessary to better understand the action mechanism of these drugs, which will in turn help us to understand how to improve their efficacy and safety. These studies will hopefully pave the path for a personalized medicine.

Immunogenicity and Loss of Effectiveness of Biologic Therapy for Inflammatory Bowel Disease Patients Due to Anti-Drug Antibody Development

“…The nomenclature of the most common mAbs used in IBD therapy are based on their derivation: murine (-omab), chimeric (-ximab), humanized (-zumab), and entirely human (-umab). An understanding of the pathophysiological mechanisms of IBD is critical before discussing immunogenicity [ 19 ].…”

Dual function of fungi-derived cytokines in inflammatory bowel diseases: protection or inflammation

“…Four of them are widely used in the treatment of IBD: infliximab, adalimumab, golimumab, and certolizumab pegol. They generally bind to TNF-α and cause cell lysis of macrophages and T cells [ 9 ]. Intravenous administration of infliximab induces and maintains clinical remission and mucosal healing in patients with refractory or unresponsive IBD [ 108 ].…”

“…The altered cytokine network could result in either susceptibility or resistance to IBD. Therefore, recent biological therapies have targeted particular cytokines for better disease control; however, some of these potent biologic agents failed to induce remission [ 9 ]. Despite cytokines with a predictable role in either amplifying or attenuating inflammation of IBD, a few cytokines showed a dual function in the inflammatory state of the intestine [ 10 ].…”

Biological treatment approach to inflammatory bowel disease is similar in academic and nonacademic centres – prime time for decentralisation of inflammatory bowel disease care?

“…The management of the disease is complex, as it includes invasive diagnostics and imaging. Fortunately, several new treatments, including monoclonal antibodies against tumour necrosis factor-alpha, integrins, interleukins, and Janus kinase inhibitors [3], have become available in recent years. Nevertheless, the management of these patients typically involves multidisciplinary teams due to many aspects of the disease and treatments.…”