The current state of the art for biological therapies and new small molecules in inflammatory bowel disease

Abstract

The emergence of biologic therapies is arguably the greatest therapeutic advance in the care of inflammatory bowel disease (IBD) to date, allowing directed treatments targeted at highly specific molecules shown to play critical roles in disease pathogenesis, with advantages in potency and selectivity. Furthermore, a large number of new biologic and small-molecule therapies in IBD targeting a variety of pathways are at various stages of development that should soon lead to a dramatic expansion in our therapeutic armamentarium. Additionally, since the initial introduction of biologics, there have been substantial advances in our understanding as to how biologics work, the practical realities of their administration, and how to enhance their efficacy and safety in the clinical setting. In this review, we will summarize the current state of the art for biological therapies in IBD, both in terms of agents available and their optimal use, as well as preview future advances in biologics and highly targeted small molecules in the IBD field.

Evaluation of The Role of Fecal Microbiota Transplantation in The Management of Ulcerative Colitis in Egyptian Patients

“…Patients of both groups start with high CRP level (29.8) in group I and (30.3) in group II then reduction in ESR achieved on both groups along the study, By the 24th week CRP become normal on both groups (3) in group I and (2,7) in group II. The clinical response is defined as reduction in mayo score equal or less than three points from base line score.…”

Conserved transcriptomic profile between mouse and human colitis allows temporal dynamic visualization of IBD-risk genes and unsupervised patient stratification

“…The identification of UC2 which is characterized by responsiveness to both IFX and VDZ may have direct implications in the clinical setting. For example, it indicates that UC2 patients would benefit from a treatment with IFX only, since IFX therapy has a higher response rate 6 and is more cost-effective compared to VDZ 39 . On the other hand, identification of non-responsiveness to both IFX and VDZ in the UC1 patient subgroup, suggests that another line of therapy should be applied.…”

“…Although there is no definitive cure for UC, there are biological therapies available which target the inflammatory response during UC by means of inhibiting pro-inflammatory cytokines or by blocking immune cell migration 3 . Among these, the most frequently used biological therapies in UC patients block tumor necrosis factor (TNF) with anti-TNF antibodies (such as infliximab, IFX) 4 or leukocyte migration (such as vedolizumab, VDZ) 5 6 . However, about 35% 4,6 and 50% 5,6 of patients poorly achieve clinical response to IFX and VDZ, respectively.…”

“…Among these, the most frequently used biological therapies in UC patients block tumor necrosis factor (TNF) with anti-TNF antibodies (such as infliximab, IFX) 4 or leukocyte migration (such as vedolizumab, VDZ) 5 6 . However, about 35% 4,6 and 50% 5,6 of patients poorly achieve clinical response to IFX and VDZ, respectively. Patients that do not respond develop adverse effects, most notably increased risk of infections, thus requiring continuous medical monitoring and ultimate surgical intervention 7,8 .…”

“…Furthermore, while there is an obvious clinical heterogeneity among UC patients as seen for example by the location affected (i.e. distal colitis, left-sided and pancolitis, and responder and non-responder) and the extent of the severity, initial treatment for these patient subgroups is identical and modified only if the patients have not responded 6,8 . Biomarkers that could distinguish the different entities of the UC spectrum are currently lacking and they are required in order to achieve the highly needed stratification of UC patients into molecularly functional subgroups 8,11 .…”