Biologics: how far can they go in Crohn's disease?

Abstract

Crohn's disease is a chronic gastrointestinal inflammatory disorder, characterized by episodes of relapsing and remitting flares. As the disease mechanism becomes better elucidated, there is a significant increase in the number of available biologic therapies. This article summarizes and synthesizes current Food and Drug Administration-approved biological therapy for Crohn's disease and examines the positioning of medical therapy as emerging biologics break onto the market.

Keywords: Crohn’s disease; JAK inhibitors; S1P-inhibitors; anti-TNFs; anti-integrins; anti-interleukins; biologics; medical treatment.

Figure 1.

Proposed algorithm for endoluminal Crohn’s disease. In luminal disease, risk stratification based on disease severity and patient risk factors helps to guide management. Patients who are high-risk have severe disease, perianal fistulas, and/or disease-related complications. Those who are risk-averse may have more co-morbidities, increased age, history of serious infection, or malignancy. This approach can help plan for first-line, second-line, and future therapies

Figure 2.

Proposed algorithm for fistulizing Crohn’s disease (CD). In fistulizing CD, evaluation of the anatomy is essential in determining the next steps. Clinical status, especially sepsis, help to decide on early surgical intervention. Early medical management should use anti-TNFs (infliximab [IFX] > adalimumab [ADA] > certolizumab pegol [CZP]) combined with an immunomodulator. If maintained response is not achieved with dose escalation and therapeutic drug monitoring, ustekinumab (UST) or vedolizumab (VDZ) can be considered. Advanced therapies included mesenchymal stem-cell transplant and surgery.