title: Balancing the risks and benefits of biologic therapy in inflammatory bowel diseases.
abstract: BACKGROUND
  The incidence of Inflammatory Bowel Diseases (IBD) is rising and overall epidemiology is changing. Goals of IBD therapy are also fast changing to reflect the concept of mucosal healing. IBD management is increasingly revolving around questions of ideal positioning of biologic therapies.
  
  
  METHODS
  This paper covers important concepts regarding two classes of biologic medications approved for treatment of IBD in the United States - anti-TNF-α agents and lymphocyte-homing antagonists. Topics covered include drug mechanism of action, pharmacokinetic considerations for the clinician including therapeutic drug monitoring, summary of current evidence of drug efficacy in IBD focusing on randomized, controlled trial data. Additionally, nuanced discussion of medication side-effects and adverse reactions is presented.
  
  
  CONCLUSIONS
  Paradigms of treatment goals in IBD are changing with increasing focus on mucosal healing. Concomitantly, our understanding of important factors that impact drug pharmacokinetic/pharmacodynamics relationships with biologic agents has increased which will help eventually develop personalized algorithms to optimize the efficacy of these agents. Though direct head-to-head comparisons between these agents are lacking, biologic agents can be considered the safest and most effective therapies introduced for IBD.
authors.affiliation: a Division of Gastroenterology and Hepatology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA.
authors.forename: Itishree
authors.initials: I
authors.lastname: Trivedi
authors.affiliation: a Division of Gastroenterology and Hepatology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Hanauer
mesh_terms: D001691:Biological Therapy / Q000009:adverse effects / Q000379:methods*; D016903:Drug Monitoring / Q000379:methods; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology; D008214:Lymphocytes / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Inflammatory Bowel Disease (IBD); anti-TNF-ɑ therapy; biologics; lymphocyte-homing antagonists