title: Biologic Therapies in Ulcerative Colitis: Primi Inter Pares?
abstract: In the last decade, the introduction of the first anti-tumor necrosis factor (TNF)-α agent infliximab has revolutionized the treatment of ulcerative colitis (UC). However, this drug is not a magic bullet since up to 50% of UC patients do not respond (primary failure) or lose response to infliximab (secondary failure). Hence the demand for novel drugs to fill the unmet medical need.
  
  
  
  The aim of this review is to discuss the data from randomized controlled trials (RCTs) of available biological agents for the treatment of moderate-to-severe UC in adults, in order to support clinical decision making.
  
  
  
  New biological agents are now available for the treatment of moderate-tosevere UC. Adalimumab and golimumab are anti-TNF-α monoclonal antibodies, as is infliximab, whereas vedolizumab blocks the integrin α4β7/mucosal addressin cell adhesion molucule-1 (MAd- CAM). Additions to the therapeutic arsenal boost the chances of successful treatment of UC, but lead to difficulty choosing the most appropriate biological drug: which biologic to use first and when and how to switch. In the absence of head-to-head trials to answer these questions, a network metaanalysis of the available RCTs can provide estimates of relative efficacy between interventions. Other factors, including convenience and satisfaction for the patient, route of administration, the cost of treatment, and the safety and efficacy profile, should all be considered.
authors.affiliation: IBD Center, Gastroenterology, IRCCS Humanitas, Rozzano, Milan, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Allocca
authors.affiliation: IBD Center, Gastroenterology, IRCCS Humanitas, Rozzano, Milan, Italy.
authors.forename: Gionata
authors.initials: G
authors.lastname: Fiorino
authors.affiliation: IBD Center, Gastroenterology, IRCCS Humanitas, Rozzano, Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Gilardi
authors.affiliation: IBD Center, Gastroenterology, IRCCS Humanitas, Rozzano, Milan, Italy.
authors.forename: Paoletta
authors.initials: P
authors.lastname: Preatoni
authors.affiliation: Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Papa
authors.affiliation: Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Lorraine University, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.affiliation: IBD Center, Gastroenterology, IRCCS Humanitas, Rozzano, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D001691:Biological Therapy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Anti-integrins; adalimumab; anti-TNF agents; biologic therapy; golimumab; infliximab; ulcerative colitis; vedolizumab.