The Expanding Therapeutic Armamentarium for Inflammatory Bowel Disease: How to Choose the Right Drug[s] for Our Patients?

J Crohns Colitis. 2018 Jan 5;12(1):105-119. doi: 10.1093/ecco-jcc/jjx117.

Abstract

The therapeutic landscape for inflammatory bowel disease [IBD] is rapidly evolving. Two new biologic drugs, vedolizumab and ustekinumab, have recently entered the marketplace, the first biosimilars have been introduced, and several other agents are at an advanced stage of clinical development. In parallel, therapeutic goals have shifted from symptom control towards mucosal healing and prevention of bowel damage. In the coming years, gastroenterologists will be faced with unprecedented choices when selecting the best treatment for their patients with IBD. In this article, we review existing data on the mechanisms of action, efficacy, and safety of recently approved and late-stage pipeline therapies, and use this information to speculate on the positioning of these drugs, alone or in combination, in therapeutic algorithms for Crohn's disease and ulcerative colitis.

Keywords: IL-23 antagonists; JAK inhibitors; Smad7; TNF antagonists; inflammatory bowel disease; pipeline; sphingosine-1 phosphate; therapy.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Algorithms
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Cell Adhesion Molecules
  • Colitis, Ulcerative / drug therapy*
  • Crohn Disease / drug therapy*
  • Drug Therapy, Combination
  • Humans
  • Immunoglobulins
  • Immunosuppressive Agents / therapeutic use
  • Integrins / antagonists & inhibitors
  • Interleukin-12 / antagonists & inhibitors
  • Interleukin-23 / antagonists & inhibitors
  • Janus Kinases / antagonists & inhibitors
  • Molecular Targeted Therapy*
  • Mucoproteins / antagonists & inhibitors
  • Protein Kinase Inhibitors / adverse effects
  • Protein Kinase Inhibitors / therapeutic use*
  • Smad7 Protein / antagonists & inhibitors
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Vascular Cell Adhesion Molecule-1 / antagonists & inhibitors

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal, Humanized
  • Cell Adhesion Molecules
  • Immunoglobulins
  • Immunosuppressive Agents
  • Integrins
  • Interleukin-23
  • MADCAM1 protein, human
  • Mucoproteins
  • Protein Kinase Inhibitors
  • SMAD7 protein, human
  • Smad7 Protein
  • Tumor Necrosis Factor-alpha
  • Vascular Cell Adhesion Molecule-1
  • integrin alpha4beta7
  • Interleukin-12
  • Janus Kinases