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Minerva Gastroenterology 2022 September;68(3):319-32

DOI: 10.23736/S2724-5985.21.02985-5


lingua: Inglese

Beyond biologics: advanced therapies in inflammatory bowel diseases

Giacomo CAIO 1, 2, 3, 4, Lisa LUNGARO 1, 5, Giuseppe CHIARIONI 6, 7, Fiorella GIANCOLA 1, Fabio CAPUTO 1, 3, 4, 5, Matteo GUARINO 1, Umberto VOLTA 8, Gianni TESTINO 9, 10, Rinaldo PELLICANO 11, Giorgio ZOLI 1, 3, 4, 5, Roberto DE GIORGIO 1, 3, 4

1 Department of Translational Medicine, University of Ferrara, Ferrara, Italy; 2 Mucosal Immunology and Biology Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA; 3 Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy; 4 Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy; 5 Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy; 6 Division of Gastroenterology, University Hospital of Verona, Verona, Italy; 7 Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 8 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; 9 Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 c/o IRCCS San Martino Hospital, Genoa, Italy; 10 Italian Society on Alcohol, Bologna, Italy; 11 Unit of Gastroenterology, Molinette Hospital, Turin, Italy

INTRODUCTION: Inflammatory bowel diseases (IBDs) are conditions affecting the gut at different levels characterized by an abnormal activation of the intestinal immune system. In this narrative review, we will provide the reader with an update on the efficacy and safety of new pharmacological strategies to treat IBD patients.
EVIDENCE ACQUISITION: We performed a thorough literature review via PubMed, EMBASE, MEDLINE and Science Direct databases addressing studies reporting on new therapies for IBD management published in the last ten years (January 2010-December 2020). Data from pharmaceutical companies and abstracts of conferences/meetings have also been considered.
EVIDENCE SYNTHESIS: The discovery of monoclonal antibodies blocking pro-inflammatory cytokines, e.g., tumor necrosis factor-α (TNF-α) radically changed the management of IBDs. Anti-TNF-α agents represent the prototype molecule of “biologics”/“biologicals.” These compounds have significantly improved the therapeutic management of IBDs refractory to standard medications as they provide clinical remission, mucosal healing and prevent extra-intestinal manifestations. However, about 50% of patients treated with biologicals experienced drawbacks, including primary failure or loss of response, requiring new effective treatments. Translational studies have identified new strategies, different from the TNF-α blockade, and new molecules, e.g. sphingosine-1-phosphate agonists and the JAK kinase inhibitors, have been proposed as potential therapeutic options for IBDs.
CONCLUSIONS: With the availability of novel approaches reviewed in this article, physicians and especially gastroenterologists will increase the therapeutic options to provide a better management of IBD patients, particularly those poorly responsive to biologicals.

KEY WORDS: Crohn disease; Colitis, ulcerative; Therapeutics

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