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Current Status of Medical Therapy for Inflammatory Bowel Disease: The Wealth of Medications

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Abstract

Previously, the natural history of Crohn’s disease and ulcerative colitis included significant morbidity due to limited treatment options that were not without serious side effects. Early treatment options included corticosteroids as well as mesalamine, thiopurines, and methotrexate. In 1998, monoclonal antibodies to a key inflammatory cytokine, TNFα, became available. Over the next 22 years, the field of gastroenterology has seen multiple new treatments emerging for inflammatory bowel disease (IBD) that target different aspects of the inflammatory cascade, significantly changing the therapeutic landscape. Additional monoclonal antibodies are available that target the integrins, which are adhesion proteins that traffic inflammatory leukocytes. Small molecule inhibitors block the inflammatory signals of several cytokines. New therapies that modulate lymphocyte escape from lymphoid tissue are promising. Lastly, stem cell technology has emerged as a platform to successfully treat perianal fistulizing disease. Our aim is to summarize the currently available therapies for IBD beyond steroids, mesalamine, and immune modulators. We highlight the most important clinical trials that have brought these treatments to clinical practice, and we discuss the ongoing clinical trials of novel therapies that have a high probability of eventual regulatory approval.

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Abbreviations

AMI:

Amiselimod

APC:

Antigen presenting cells

cAMP:

Cyclic adenosine monophosphate

CDAI:

Crohn’s Disease Activity Index

IFX:

Infliximab

ITGAE:

Integrin alpha E gene

JAK:

Janus kinase

MSC:

Mesenchymal stem cells

OZA:

Ozanimod

PDE4:

Phosphodiesterase-4

PF:

PF-00547659/ontamalimab

PML:

Progressive multifocal leukoencephalopathy

S1P:

Sphingosine-1-phosphate

STAT:

Signal transducers and activators of transcription

TNF:

Tumor necrosis factor

TYK:

Tyrosine kinase

UST:

Ustekinumab

VDZ:

Vedolizumab

VTE:

Venous thromboembolism

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Authors and Affiliations

  1. Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

    Neil Nadpara, Zachary Wilmer Reichenbach, Adam C. Ehrlich & Frank Friedenberg

  2. Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

    Zachary Wilmer Reichenbach

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  1. Neil Nadpara
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  2. Zachary Wilmer Reichenbach
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Contributions

NN, PGY-1, resident in internal medicine, wrote the manuscript, contributed to the final edits, and approved the final manuscript. ZWR, PGY-5, fellow in gastroenterology, wrote the manuscript, contributed to the final edits, and approved the final manuscript. ACE, attending in gastroenterology, wrote the manuscript, contributed to the final edits, and approved the final manuscript. FF developed the topic and outline of the manuscript, wrote the manuscript, contributed to the final edits, and approved the final manuscript.

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Correspondence to Frank Friedenberg.

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Nadpara, N., Reichenbach, Z.W., Ehrlich, A.C. et al. Current Status of Medical Therapy for Inflammatory Bowel Disease: The Wealth of Medications. Dig Dis Sci 65, 2769–2779 (2020). https://doi.org/10.1007/s10620-020-06471-4

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