Biologics: how far can they go in Crohn’s disease?

Abstract

Crohn’s disease is a chronic gastrointestinal inflammatory disorder, characterized by episodes of relapsing and remitting flares. As the disease mechanism becomes better elucidated, there is a significant increase in the number of available biologic therapies. This article summarizes and synthesizes current Food and Drug Administration-approved biological therapy for Crohn’s disease and examines the positioning of medical therapy as emerging biologics break onto the market.

Remission of refractory Crohn's disease with anti‐IL‐12/23 therapy in a patient undergoing hemodialysis: A case report

“…Despite advances in the understanding and treating this condition, CD remains uncurable, and pharmacologic intervention aims at managing the symptoms and halting disease progression 2 . Biologics have signified the beginning of a new era in the management of CD patients and are currently considered the cornerstone of CD therapy 3 . However, primary and secondary nonresponse to biologic agents, such as the anti‐TNF‐alpha monoclonal antibodies infliximab and adalimumab, remains a serious unresolved impediment to the use of these drugs 6 .…”

“…However, primary and secondary nonresponse to biologic agents, such as the anti‐TNF‐alpha monoclonal antibodies infliximab and adalimumab, remains a serious unresolved impediment to the use of these drugs 6 . Ustekinumab, an anti‐IL‐12/23 receptor antibody, offers an attractive alternative by targeting a different pathway in the development of adaptive immune responses 3 . Nevertheless, evidence on whether it proves a better option in primary and secondary nonresponders than a second anti‐TNF‐α agent are still lacking 6 .…”

“…With the advent of biologics, a new era in the treatment of IBD began, offering the clinician a wide variety of potent pharmacotherapeutic options. Ustekinumab, a monoclonal antibody targeting the common p40 subunit of IL‐12 and IL‐23 receptors, is currently being used in clinical practice as second line therapy to anti‐TNF‐α antibodies and is increasingly gaining popularity as first line therapy for average risk CD patients 3 …”

Do Crohn's disease patients benefit from an optimized adalimumab therapy?

“…Based on the data from the CLASSIC II trial, adalimumab 40 mg every other week is recommended as a standard maintenance dosage [7]. Clinical evidences have also demonstrated that the trough concentration of adalimumab is positively correlated with the clinical response and mucosal remission of CD [8][9][10]. Dose escalation or shortening dosing frequency is a promising strategy to require the secondary unresponsiveness to adalimumab, which may be attributed to the increased concentration of adalimumab [11].…”

“…This study aimed to assess the e cacy and safety of an optimized dose versus a standard dose of adalimumab in the treatment of CD, especially for CD patients experiencing treatment failure of in iximab. from adalimumab therapy to the last follow-up visit was less than 12 weeks of; (6) the patient was managed by an adalimumab therapy at different dosages, rather than 40 mg (optimized dose regimen) or 80 mg (standard dose regimen) adalimumab every other week; (7) the patients was accompanied with central nervous diseases; (8) severe cardiopulmonary, liver or kidney dysfunction; (9) malignancies; (10) active tuberculosis, hepatitis B, severe immune de ciency, post-organ transplantation, or severe infection.…”