The main goals of treating Inflammatory Bowel Disease (IBD), including Crohn’s Disease and Ulcerative Colitis, are to induce and maintain remission, prevent the development of complications, reduce the need for surgery, and live a better quality of life.
Oral Aminosalicylates and Corticosteroids have long been a staple in the management of IBD, and can be effective in inducing symptomatic remission. This approach, however, has not proven to reduce long-term complications or improve patient outcomes. Clinicians and researchers have been seeking therapeutic approaches that address mucosal healing and generate improved long-term outcomes.
Scientific advances in understanding IBD have resulted in the development of multiple new therapies as alternatives to current treatments.
New medications that are currently approved for the treatment of IBD are:
- Infliximab
- Adalimumab
- Certolizumab pegol
- Golimumab
- Vedolizumab
- Ustekinumab
- Tofacitinib
Infliximab, Adalimumab, Golimumab, and Certolizumab Pegol belong to a class of medications, called anti-tumor necrosis factor (TNF) agents. The basis for using these agents is TNF-alpha has several biologic activities that may directly relate to immune system dysregulation and IBD development.
Infliximab was initially approved by the FDA for use in the treatment of Crohn’s Disease. In 2005, the FDA also approved the use of Infliximab in the treatment of Ulcerative Colitis.
Subsequently, Adalimumab was approved by the FDA to treat Crohn’s disease in 2007, and in 2012 to treat ulcerative colitis.
In 2013 Golimumab was approved by FDA for the treatment of moderately to severely active ulcerative colitis (UC) in adults
Certolizumab pegol was approved in 2008 for treatment of moderate to severe Crohn’s disease.
Vedolizumab became an anti-integrin agent approved in the treatment of ulcerative colitis and Crohn’s disease in 2014. This medication blocks the migration of leukocytes (white blood cells) to the gut, thus reducing inflammation.
Ustekinumab was approved in 2016 for the treatment of Crohn’s disease and blocks inflammation brought on by interleukins.
Tofacitinib is the first oral medication approved for the treatment of moderate to severe ulcerative colitis. Approved in 2018, this medication is a selective Janus Kinase Inhibitor, which works by modifying the immune system.
Multiple other potential drugs are now in the development pipeline. Medications that have been studied in clinical trials include Upadacitinib, Filgotinib, Etrolizumab, Brazikumab, Risankizumab, Mirikizumab, and Ozanimod.
