In a recent study published in the journal eGastroenterology, researchers delved into the latest therapeutic strategies for managing inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease.
By Dr. Liji Thomas, MDNov 8 2023Reviewed by Benedette Cuffari, M.Sc. Inflammatory bowel disease refers to a spectrum of chronic bowel inflammatory conditions, primarily ulcerative colitis and Crohn’s disease . These autoimmune mucosa-damaging conditions cause pain, bloating, indigestion, and acute abdominal emergencies, severely reducing the quality of life in the long term.
People with IBD often fail all available drugs initially or following a relapse, with less than 60% response rates in clinical trials. However, many new IBD drugs are under development or have been approved that elicit promising responses in moderate-to-severe IBD after treatment failures with several other drugs.
Newer oral agents can treat the diseased gut directly, thereby reducing systemic exposure, which is associated with the risk of opportunistic infection, reactivation of tuberculosis, and cancer. These include AVX-470 and AVX-470m, which are bovine colostrum-derived drugs that act like infliximab. Cytokine inhibitors These agents inhibit pro-inflammatory cytokines like interleukins , especially IL-12 and IL-23. Ustekinumab is the first anti-IL drug to be developed or approved for IBD and blocks both IL-12 and IL-23 through their p40 subunit.
S1P receptor modulators S1P is a lipid molecule that triggers S1P1 - S1P5 receptors to regulate lymphocyte migration from the primary lymphoid organs into the bloodstream. S1PRM blocks this signaling pathway, thereby causing S1P to break down. In addition to reducing inflammation, these agents may also lead to lymphopenia and cardiovascular events, thus necessitating rigorous patient selection.
The future A combination of infliximab with azathioprine was found to be more effective than monotherapy, as it improves infliximab bioavailability and reduces infliximab antibody formation. Concomitant immunosuppressive therapy enhances remission rates at all drug concentrations, even with drug antibodies present.
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