Biologic agents for IBD: practical insights.
Six biologic agents are currently approved for the treatment of IBD: four anti-TNF agents (infliximab, adalimumab, golimumab and certolizumab pegol) and two anti-integrin agents (natalizumab and vedolizumab). In Crohn's disease and ulcerative colitis refractory to standard medications, treatment choice among available biologic agents can be challenging. Several parameters should be taken into account to help physicians through the decision-making process, including the comparative effectiveness and long-term safety profile, availability and labelling in the prescriber's country, international guidelines, and cost, as well as patient preferences (such as the route of administration). Herein, we provide practical insights on the use of biologic agents in IBD. The results of head-to-head trials between biologic agents are eagerly awaited to guide decision-making regarding the choice of first-line biologic agents and to determine whether switching within the same drug class or swapping (switching out of the drug class) is preferable after primary or secondary loss of response to the first biologic agent. In the near future, treatment algorithms might evolve with the launch of new drugs (such as ustekinumab, tofacitinib and etrolizumab) and the increased use of biosimilars.
Department of Gastroenterology, IBD Centre, Humanitas Research Hospital, Via A. Manzoni 56, 20089 Rozzano, Milan, Italy.
Silvio
S
Danese
Department of Gastroenterology, University Hospital of Besançon, 3 Boulevard Fleming, 25030 Besançon, France.
Lucine
L
Vuitton
Inserm U954, and Department of Gastroenterology, University Hospital of Nancy, 5 Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, Nancy, France.
Laurent
L
Peyrin-Biroulet
D000465:Algorithms; D001685:Biological Factors / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D004348:Drug Labeling; D005544:Forecasting; D006801:Humans; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D013997:Time Factors; D016896:Treatment Outcome
D001685:Biological Factors