Biologics can treat some cases of inflammatory bowel disease

December 1, 2009

For the 15% to 20% of patients who don't respond to initial treatment, tumor necrosis factor inhibitors can reduce inflammation

INFLAMMATORY BOWEL DISEASE (IBD) includes ulcerative colitis and Crohn's disease, two distinct conditions with similar symptoms, in which the intestines become inflamed, probably as a result of the body's immune reaction mobilized against intestinal tissue. Ulcerative colitis affects the colon and the rectum, while Crohn disease's may affect any portion of the gastrointestinal tract (most often the small intestine and/or the colon.) Symptoms typically include diarrhea, abdominal pain, nausea and vomiting, fever and weight loss. Sometimes there are associated complaints such as arthritis or skin problems.

Most patients have sporadic symptoms. About 20% to 25% have frequently relapsing disease, or chronically active disease. Drugs to treat IBD include mesalamine (a substance that helps control inflammation), antibiotics, corticosteriods, and immunosuppressants.

"For patients with mild to moderate disease, initial treatment would depend on their specific condition," says Bruce Sands, MD, MS, vice chair of the American Gastroenterological Association Institute. "A person with moderate disease might have diarrhea three or four times a day, and some degree of urgency and belly pain, but they can take in adequate nutrition, and they are able to function in daily life."

These medications are biologic substances that can locate and bind to the specific molecules involved in causing inflammation. Today, three TNF inhibitors are approved by the FDA for treatment of moderate to severe Crohn's disease that has not responded to other drugs: Cimzia (certolizumab pegol), Humira (adalimumab), and Remicade (infliximab).

"TNF inhibitors were a completely different type of agent that could produce a response in patients who had been refractory to all existing therapies," says Dr. Sands. "Before the advent of TNF inhibitors, I had patients who were completely homebound by the disease. Not every patient responds, and some have a partial response, but in many cases patients were able to return to work and a normal lifestyle."

These medications have side effects, which may include the risk of infection or rare cases of lymphoma, says Dr. Sands. When patients have mild symptoms, typically those medications are not recommended.