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Biologic agents for IBD: practical insights

Nature Reviews Gastroenterology & Hepatology volume 12, pages 537–545 (2015)Cite this article

Subjects

Key Points

  • Six biologic agents are currently approved for the treatment of IBD refractory to standard medications: four anti-TNF agents, infliximab, adalimumab, golimumab, certolizumab pegol; and two anti-integrin agents, natalizumab and vedolizumab

  • When choosing a first-line biologic agent, several parameters should be taken into account, including specific country availability and labelling, efficacy and safety profile, route of administration, patient preferences and cost-effectiveness

  • The sequence of prescribing anti-TNF therapies relative to vedolizumab will be assessed in further head-to-head trials; currently, labelling is similar for both drug classes

  • No switch between anti-TNF agents should be proposed in instances of adequate primary response to a first-line anti-TNF therapy

  • For secondary loss of response to a first-line anti-TNF agent, a second-line anti-TNF therapy could be proposed; primary nonresponders should be swaped to biologic agents with a different mechanism of action

  • In the next few years, results of head-to-head trials will be available to help decision-making between therapeutic options for IBD and treatment algorithms will evolve with the launch of biosimilars and new drugs

Abstract

Six biologic agents are currently approved for the treatment of IBD: four anti-TNF agents (infliximab, adalimumab, golimumab and certolizumab pegol) and two anti-integrin agents (natalizumab and vedolizumab). In Crohn's disease and ulcerative colitis refractory to standard medications, treatment choice among available biologic agents can be challenging. Several parameters should be taken into account to help physicians through the decision-making process, including the comparative effectiveness and long-term safety profile, availability and labelling in the prescriber's country, international guidelines, and cost, as well as patient preferences (such as the route of administration). Herein, we provide practical insights on the use of biologic agents in IBD. The results of head-to-head trials between biologic agents are eagerly awaited to guide decision-making regarding the choice of first-line biologic agents and to determine whether switching within the same drug class or swapping (switching out of the drug class) is preferable after primary or secondary loss of response to the first biologic agent. In the near future, treatment algorithms might evolve with the launch of new drugs (such as ustekinumab, tofacitinib and etrolizumab) and the increased use of biosimilars.

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Figure 1: Available and possible future therapies for IBD and their targets.
Figure 2: Biologic agents in IBD: a proposed algorithm for clinical practice.

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Authors and Affiliations

  1. Department of Gastroenterology, IBD Centre, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, Milan, 20089, Italy

    Silvio Danese

  2. Department of Gastroenterology, University Hospital of Besançon, 3 Boulevard Fleming, Besançon, 25030, France

    Lucine Vuitton

  3. and Department of Gastroenterology, Inserm U954, University Hospital of Nancy, 5 Rue du Morvan, Vandoeuvre-lès-Nancy, Nancy, 54500, France

    Laurent Peyrin-Biroulet

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Contributions

S.D., L.P.-B. and L.V. wrote the article. All authors researched data for the article, provided a substantial contribution to discussion of content and reviewed/edited the manuscript before submission. L.P.-B. and L.V. made figures and tables.

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Correspondence to Laurent Peyrin-Biroulet.

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Competing interests

S.D. has served as a speaker, consultant and advisory board member for Abbott, Actelion, Alpha Wasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson & Johnson, Merck, Millennium Takeda, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, Schering-Plough, UCB and Vifor. L.V. has received fees for lectures from Abbvie, MSD, Norgine and consulting fees from Abbvie and Takeda. L.P.-B. has received consulting fees from Abbott, Bristol-Myers Squibb, Boehringer Ingelheim, Celltrion, Ferring, Genentech, Hospira, Janssen, Lilly, Merck, Mitsubishi, Norgine, Pharmacosmos, Pilège, Shire, Takeda, Therakos, Tillotts, UCB and Vifor, and has received lecture fees from Abbott, Ferring, HAC-pharma, Janssen, Merck, Norgine, Therakos, Tillotts and Vifor.

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Danese, S., Vuitton, L. & Peyrin-Biroulet, L. Biologic agents for IBD: practical insights. Nat Rev Gastroenterol Hepatol 12, 537–545 (2015). https://doi.org/10.1038/nrgastro.2015.135

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