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Review
. 2021 Apr 27:14:17562848211006669.
doi: 10.1177/17562848211006669. eCollection 2021.

Novel trends with biologics in inflammatory bowel disease: sequential and combined approaches

Giuseppe Privitera  1 , Daniela Pugliese  2 , Loris Riccardo Lopetuso  2 , Franco Scaldaferri  2 , Matteo Neri  3 , Luisa Guidi  1 , Antonio Gasbarrini  1 , Alessandro Armuzzi  1
Affiliations
Review

Novel trends with biologics in inflammatory bowel disease: sequential and combined approaches

Giuseppe Privitera et al. Therap Adv Gastroenterol. .

Abstract

Inflammatory bowel disease (IBD) management has changed dramatically over the past 20 years, after the introduction of targeted biological therapies. However, the impact of these new drugs in changing the natural history of disease is still under debate. Recent evidence seems to suggest that the extent of their efficacy might be, at least partially, dependent on the timing of their introduction and on the subsequent management strategy. In this complex landscape, the potential role for a more dynamic approach with treatments based on sequencing and combining targeted therapies has been explored only minimally so far. In this review, we aim to explore the potential biological rationale behind the use of sequential and combination therapies in IBD, to summarise the current knowledge on this topic and to propose a management algorithm that combines these notions.

Keywords: Crohn’s disease; combination therapy; dual targeted therapy; swap; switch; switch;; ulcerative colitis, ;.

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Conflict of interest statement

Conflict of interest statement: The authors declare the following conflicts of interest: Giuseppe Privitera received consultancy fees from Alphasigma. Daniela Pugliese received speaker fees from AbbVie, MSD, Takeda, Janssen and Pfizer. Franco Scaldaferri: advisory board for Abbvie, Janssen, MSD, Sanofi and Takeda. Luisa Guidi: consultancies and/or speaker fees from: AbbVie, Janssen, MSD, Mundipharma, Takeda, Vifor Pharma and Zambon. Antonio Gasbarrini reports personal fees for consultancy for Eisai S.r.l., 3PSolutions, Real Time Meeting, Fondazione Istituto Danone, Sinergie S.r.l. Board MRGE, and Sanofi S.p.A, personal fees for acting as a speaker for Takeda S.p.A, AbbVie, and Sandoz S.p.A, and personal fees for acting on advisory boards for VSL3 and Eisai. Alessandro Armuzzi: consulting and/or advisory board fees from AbbVie, Allergan, Amgen, Arena, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Ferring, Gilead, Janssen, Lilly, MSD, Mylan, Pfizer, Samsung Bioepis, Sandoz and Takeda; lecture and/or speaker bureau fees from AbbVie, Amgen, Biogen, Ferring, Giliead, Janssen, MSD, Mitsubishi-Tanabe, Nikkiso, Novartis, Pfizer, Sandoz, Samsung Bioepis and Takeda; and research grants from MSD, Pfizer and Takeda. All the other authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Proposed management algorithm for CD. Created with BioRender.com. ADAs, anti-drug antibodies; CD, Crohn’s disease; IMMs, immunosuppressors; TDM, therapeutic drug monitoring; TLs, trough levels.
Figure 2.
Figure 2.
Proposed management algorithm for UC. Created with BioRender.com. *Infliximab preferred as first-line agent in bionaïve patients. **Tofacitinib or ustekinumab preferred over vedolizumab as second-line agents. ADAs, anti-drug antibodies; IMMs, immunosuppressors; TDM, therapeutic drug monitoring; TLs, trough levels; UC, ulcerative colitis.
Figure 3.
Figure 3.
Implementations needed in IBD medical management. Created with BioRender.com. IBD, inflammatory bowel disease; IL, interleukin; JAK, Janus kinases; RCTs, randomised controlled trials; S1P, sphingosine-1-phosphate; TNF, tumour necrosis factor.
Figure 4.
Figure 4.
Proposed algorithm for IBD medical management, excluding cases where surgery is needed. Created with BioRender.com. IBD, inflammatory bowel disease; DTT, dual targeted therapy; IMM, immunosuppressor; TNF, tumour necrosis factor.
See this image and copyright information in PMC

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