Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia

Abstract

The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.

Keywords: Adalimumab; Colitis, ulcerative; Crohn disease; Inflammatory bowel disease; Infliximab.

Fig. 1.

Possible permutation of therapeutic drug monitoring (TDM) results. ADA, antidrug antibody.

Fig. 2.

Summary algorithm to guide management according to therapeutic drug monitoring loss of response (LOR). ADA, antidrug antibody; IM, immunomodulator.