Minerva Gastroenterol (Torino). 2022 Sep;68(3):319-332.doi: 10.23736/S2724-5985.21.02985-5. Epub 2021 Jul 26.

Giacomo Caio ^1 2 3 4, Lisa Lungaro ^1 5, Giuseppe Chiarioni ^6 7, Fiorella Giancola ¹, Fabio Caputo ^1 3 4 5, Matteo Guarino ¹, Umberto Volta ⁸, Gianni Testino ^9 10, Rinaldo Pellicano ¹¹, Giorgio Zoli ^1 3 4 5, Roberto DE Giorgio ^12 3 4

Author information

¹Department of Translational Medicine, University of Ferrara, Ferrara, Italy.

²Mucosal Immunology and Biology Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.

³Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.

⁴Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.

⁵Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy.

⁶Division of Gastroenterology, University Hospital of Verona, Verona, Italy.

⁷Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

⁸Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

⁹Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 c/o IRCCS San Martino Hospital, Genoa, Italy.

¹⁰Italian Society on Alcohol, Bologna, Italy.

¹¹Unit of Gastroenterology, Molinette Hospital, Turin, Italy.

¹²Department of Translational Medicine, University of Ferrara, Ferrara, Italy - dgrrrt@unife.it.

Abstract

Introduction: Inflammatory bowel diseases (IBDs) are conditions affecting the gut at different levels characterized by an abnormal activation of the intestinal immune system. In this narrative review, we will provide the reader with an update on the efficacy and safety of new pharmacological strategies to treat IBD patients.

Evidence acquisition: We performed a thorough literature review via PubMed, EMBASE, MEDLINE and Science Direct databases addressing studies reporting on new therapies for IBD management published in the last ten years (January 2010-December 2020). Data from pharmaceutical companies and abstracts of conferences/meetings have also been considered.

Evidence synthesis: The discovery of monoclonal antibodies blocking pro-inflammatory cytokines, e.g., tumor necrosis factor-α (TNF-α) radically changed the management of IBDs. Anti-TNF-α agents represent the prototype molecule of "biologics"/"biologicals." These compounds have significantly improved the therapeutic management of IBDs refractory to standard medications as they provide clinical remission, mucosal healing and prevent extra-intestinal manifestations. However, about 50% of patients treated with biologicals experienced drawbacks, including primary failure or loss of response, requiring new effective treatments. Translational studies have identified new strategies, different from the TNF-α blockade, and new molecules, e.g. sphingosine-1-phosphate agonists and the JAK kinase inhibitors, have been proposed as potential therapeutic options for IBDs.

Conclusions: With the availability of novel approaches reviewed in this article, physicians and especially gastroenterologists will increase the therapeutic options to provide a better management of IBD patients, particularly those poorly responsive to biologicals.