Have Biologics Changed the Natural History of Crohn's Disease?

Abstract

Crohn's disease (CD) is a progressive condition, with most patients developing a penetrating or stricturing phenotype over time. The introduction of anti-tumor necrosis factor (TNF) therapies over the past 10-15 years, which was supported by accumulating evidence both from trials and clinical practice, has led to a significant change in patient management, monitoring, and treatment algorithms. Anti-TNF therapy was demonstrated to be effective for both luminal and fistulizing disease. Regular therapy with both infliximab and adalimumab was shown to increase the likelihood of clinical remission and mucosal healing, as well as to reduce the need for surgery and hospitalization in both clinical trials and clinical practice, especially in patients with pediatric-onset CD, shorter disease duration, and when used in combination with immunosuppressives. This has led to new treatment goals and to the use of early aggressive medical therapy in a selected group of patients with a worse prognosis. Exploratory clinical trials are underway to determine if further optimization of therapies and treatment beyond clinical remission leads to superior disease outcomes. However, more long-term clinical data are needed to assess whether an early, aggressive therapeutic strategy employing anti-TNF, alone or in combination with biologicals, can further improve long-term disease outcomes in both pediatric patients and young adults.

Indian Society of Gastroenterology consensus statements on Crohn’s disease in India

“…The introduction of biologicals led to the expectation that early treatment with these very powerful agents would permanently heal CD. However, the general experience is that such an expectation has not yet been met [62,98,99].…”

“…Complete disappearance of endoscopic and histological lesions has been described as mucosal healing in CD and occurs with a variety of therapies [60,61]. The concept of mucosal healing as a therapeutic end-point gained wide currency when biologics were introduced [62,63]. Although treatment for CD is considered to be lifelong in the majority of patients, occasional patients may be candidates for cessation of therapy.…”

Tumor necrosis factor-alpha antibodies in fistulizing crohn's disease: An updated systematic review and meta-analysis

“…Commonly, the CD has a deteriorating course which can make patients' symptoms varied over time. [123] During recent years, CD incidence has raised up globally, and now, it is around 12.7/100,000 and 20.2./100,000 person-years in Europe and North America, respectively. Although CD can involve pediatrics and adults, it mainly affects adolescents and young adults.…”

Cutaneous Adverse Reactions during Anti-Tnf Alpha Treatment for Inflammatory Bowel Diseases: The Experience of the Dermatology Clinic of Cagliari

“…Impressive efficacy, with near-remission achievement and longterm functional improvement, has suggested the chance of altering the natural history of these diseases [7][8][9]. Overall, anti-TNFα biological agent therapy is well tolerated, but not devoid of side effects: infections, malignancies, demyelinating diseases, aplastic anemia, congestive heart failure and induction of autoimmune diseases [8][9][10][11][12].…”