Positioning biologic therapy for Crohn's disease and ulcerative colitis
Fernando S Velayos1, William J Sandborn
1Center for Crohn's and Colitis, University of California, San Francisco, 2330 Post Street Suite 610, San Francisco, California 94115, USA. Fernando.Velayos@ucsf.edu
Current Gastroenterology Reports
|April 2, 2008
Summary
Biologic therapies offer new options for inflammatory bowel disease (IBD). Early use ("top-down") may yield better outcomes than later use ("step-up") in IBD patients.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Biologic agents, including tumor necrosis factor-alpha and alpha4 integrin inhibitors, have transformed inflammatory bowel disease (IBD) treatment.
- Current treatment strategies debate the optimal timing for introducing biologics to balance efficacy and risk.
Purpose of the Study:
- To review the current role of biologics in IBD treatment strategies.
- To evaluate emerging evidence supporting an early (
Main Methods:
- Literature review and critical appraisal of existing data.
- Comparative analysis of
- Main_Results
- Conclusions
Main Results:
- The current standard is a "step-up" approach, reserving biologics for patients with refractory disease or steroid dependence.
- Emerging data suggest a potential benefit for a "top-down" strategy, initiating biologics earlier in the treatment algorithm.
Conclusions:
- The optimal positioning of biologics in IBD management remains an area of active investigation.
- A "top-down" approach warrants further study to determine if it offers superior long-term outcomes compared to the traditional "step-up" strategy.
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