Biologic therapies in ulcerative colitis: Primi inter pares?

Mariangela Allocca, Gionata Fiorino, Daniela Gilardi, Paoletta Preatoni, Alfredo Papa, Laurent peyrin-Biroulet, Silvio Danese

Research output: Contribution to journalReview articlepeer-review

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. New biological agents are now available for the treatment of moderate-to-severe 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 (MAdCAM). 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-tohead trials to answer these questions, a network meta-analysis 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. 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.

Original languageEnglish
JournalCurrent Drug Targets
Volume17
Issue number11
DOIs
Publication statusPublished - Sep 1 2016

Keywords

  • Adalimumab
  • Anti-integrins
  • Anti-TNF agents
  • Biologic therapy
  • Golimumab
  • Infliximab
  • Ulcerative colitis
  • Vedolizumab

ASJC Scopus subject areas

  • Molecular Medicine
  • Pharmacology
  • Drug Discovery
  • Clinical Biochemistry

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