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Crohn's disease (CD) management relies on immunosuppressants and biologics like anti-TNFα. New drugs promise improved, individualized therapies for patients with active CD.
Area of Science:
- Gastroenterology and Immunology
- Chronic Inflammatory Diseases
Background:
- Crohn's disease (CD) is a chronic, immune-mediated gastrointestinal disorder with limited understanding and no cure.
- Current treatments involve long-term immunosuppression, but efficacy is insufficient for some patients.
Purpose of the Study:
- To review established and emerging therapies for active Crohn's disease.
- To highlight the need for individualized treatment strategies.
Main Methods:
- Review of current clinical practices and pipeline drug candidates for Crohn's disease.
- Analysis of established therapies including corticosteroids, azathioprine, anti-TNFα, vedolizumab, and ustekinumab.
Main Results:
- Established therapies include corticosteroids, azathioprine, anti-TNFα antibodies, vedolizumab, and ustekinumab.
- Emerging drugs like filgotinib, upadacitinib, risankizumab, and rifaximin show promise in clinical trials.
- Mesenchymal stem cells may aid in fistula management.
Conclusions:
- The therapeutic landscape for Crohn's disease is expanding with new drug approvals.
- Optimized selection of therapeutic agents is crucial for individualized patient management.
- Future strategies will focus on tailoring treatments based on patient-specific needs and drug efficacy.
Background:
Crohn's disease (CD) is a chronic immune-mediated disorder of the gastrointestinal tract. The pathophysiological understanding of this disease is limited and no curative therapy is available so far. Therefore, most patients require long-lasting or even life-long immunosuppressive therapies for the suppression of symptoms to improve quality of life and reduction of long-term risks. However, in a relevant subgroup of patients, these therapeutic goals cannot be sufficiently attained.
Summary:
Clinically established therapies in active CD comprise corticosteroids and immunosuppressants such as azathioprine. After the introduction of anti-TNFα (Tumor necrosis factor alpha) antibodies, other biologicals (e.g., vedolizumab and ustekinumab) have also been approved. New drugs in the pipeline like filgotinib, upadacitinib, risankizumab or rifaximin could improve the therapy of CD in the near future. Thus, an individualized therapy management, based on optimal selection of therapeutic agents will become more important. Additionally, the local application of mesenchymal stem cells might be helpful in the management of fistulas. Key Messages: The targeted biological therapeutic agents (anti-TNFα antibodies, vedolizumab, ustekinumab) are well established for therapy in CD. There are several new substances in the pipeline with promising results in phase II trials (filgotinib, rifaximin, risankizumab, upadacitinib). The upcoming extension of the therapeutic arsenal will require methods for an optimized selection of substances, thus enabling a more individualized therapy.