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Should we use anti-tumor necrosis factor agents or vedolizumab as first-line biological therapy in ulcerative
Lieven Pouillon1, Johan Van Stappen2, Peter Bossuyt3
1Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, 1 Allée du Morvan, 54511, Vandoeuvre-lès-Nancy, France; Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Imeldalaan 9, 2820, Bonheiden, Belgium.
Abstract:
Randomized controlled trials with direct comparisons between the different available biological agents in ulcerative colitis are lacking. The comparative efficacy, safety and tolerability, patient profile, patient preference and costs should be taken into account when choosing an appropriate first-line biological. Tumor necrosis factor antagonists have a systemic mode of action, while vedolizumab is mainly gut-selective, and this influences the clinical profile of both treatment options. Tofacitinib will further expand the therapeutic armamentarium in ulcerative colitis. Results of ongoing head-to-head trials between biological agents are likely to change clinical practice in the near future. Biomarkers that predict response to different treatment options in an individual patient are warranted.
Insights
Direct comparisons of biological agents for ulcerative colitis are limited. Choosing the best first-line treatment requires considering efficacy, safety, patient factors, and cost. Ongoing trials may soon impact clinical practice.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Randomized controlled trials directly comparing available biological agents for ulcerative colitis (UC) are scarce.
- Selecting first-line biological therapy necessitates evaluating comparative efficacy, safety, tolerability, patient profiles, preferences, and costs.
- Current biologicals, such as systemic tumor necrosis factor (TNF) antagonists and gut-selective vedolizumab, possess distinct mechanisms of action influencing their clinical utility.
Purpose of the Study:
- To highlight the need for head-to-head trials comparing biological agents in ulcerative colitis.
- To emphasize the multifaceted criteria for selecting appropriate first-line biological therapy.
- To discuss the evolving landscape of UC treatment with emerging agents like tofacitinib.
Main Methods:
- This review synthesizes current knowledge on biological agents for UC.
- It discusses the comparative aspects of different treatment modalities based on available data and clinical experience.
- It anticipates the impact of ongoing and future comparative trials.
Main Results:
- The lack of direct comparative trials poses a challenge for optimal treatment selection in UC.
- Systemic versus gut-selective mechanisms of action lead to different clinical profiles for biological agents.
- Tofacitinib represents a new therapeutic option, further diversifying treatment choices.
Conclusions:
- Comparative trials are crucial for guiding clinical practice and optimizing patient outcomes in ulcerative colitis.
- A comprehensive approach considering efficacy, safety, patient-specific factors, and cost is essential for choosing first-line biological therapy.
- The development of predictive biomarkers is warranted to personalize treatment selection for individual patients with UC.
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