Beyond biologics: advanced therapies in inflammatory bowel diseases

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 4Lisa Lungaro 1 5Giuseppe Chiarioni 6 7Fiorella Giancola 1Fabio Caputo 1 3 4 5Matteo Guarino 1Umberto Volta 8Gianni Testino 9 10Rinaldo Pellicano 11Giorgio Zoli 1 3 4 5Roberto 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.


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.



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