title: Immunomodulators in inflammatory bowel disease: an emerging role for biologic agents.
abstract: Crohn's disease and ulcerative colitis, collectively referred to as inflammatory bowel diseases (IBD), are the result of an aberrant immune response to ubiquitous antigens in a genetically susceptible host. In the past, treatment has focused on immunosuppression with the aim of achieving symptom-free remission. Over the last two decades, with a better understanding of the underlying pathomechanisms and an increased knowledge of the natural disease course, mucosal healing (the endoscopic absence of visible inflammation) has become the target of therapy. Anti-tumor necrosis factor (TNF)-α therapy was introduced in the late 1990s and, for the first time, targeted and effective medication became available. However, these medications are not without significant side effects, and long-term efficacy is only achieved in about one third of patients. Alongside anti-TNF-α agents, a variety of other drugs targeting different aspects of the immune system will become available over the next few years. This review aims to provide a brief summary of immunologic pathways involved in IBD and shows where current and new drugs fit into these pathways.
authors.affiliation: Department of Microbiology and Immunology, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Kemp
authors.forename: Elliott
authors.initials: E
authors.lastname: Dunn
authors.forename: Michael
authors.initials: M
authors.lastname: Schultz
mesh_terms: D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D015195:Drug Design; D020022:Genetic Predisposition to Disease; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D058990:Molecular Targeted Therapy; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha