Positioning biologic therapy for Crohn's disease and ulcerative colitis.
Over the past decade, the introduction of biologic agents such as tumor necrosis factor-alpha and alpha4 integrin leukocyte adhesion molecule inhibitors has provided new and effective treatment options for patients with inflammatory bowel disease (IBD). Recent debates have centered on where biologics should be positioned within the current treatment strategy so as to maximize efficacy while balancing risk. This review highlights the current position biologics hold relative to conventional therapies within the current "step-up" treatment strategy. It also critically appraises emerging data, testing the hypothesis that positioning biologics early in the IBD treatment algorithm ("top-down" strategy) results in superior outcomes compared with the current step-up strategy, in which biologics are used only in patients failing conventional therapies or who are steroid dependent.
Velayos
Fernando S
FS
Center for Crohn's and Colitis, University of California, San Francisco, 2330 Post Street Suite 610, San Francisco, California 94115, USA. Fernando.Velayos@ucsf.edu
Sandborn
William J
WJ
D000068879:Adalimumab; D000465:Algorithms; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001691:Biological Therapy; D000068582:Certolizumab Pegol; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage; D007155:Immunologic Factors / Q000627:therapeutic use; D000069285:Infliximab; D007413:Intestinal Mucosa / Q000503:physiopathology; D000069442:Natalizumab; D011092:Polyethylene Glycols / Q000008:administration & dosage; D012074:Remission Induction; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014945:Wound Healing
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007140:Immunoglobulin Fab Fragments; D007155:Immunologic Factors; D000069442:Natalizumab; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol