IBD: From conventional immunosuppression to biological therapy

Abstract

Background Inflammatory bowel diseases (IBD) are chronic recurrent inflammatory diseases with partly understood etiology and pathogenesis. The course of IBD, both ulcerative colitis (UC) and Crohn`s disease (CD) is characterized by periods of relapse and remission with the possible occurrence of extraintestinal manifestations. Summary During the last decades therapeutic goals in IBD evolved towards endoscopic remission and mucosal healing creating the need for early administration of disease-modifying agents (DMA). DMA includes conventional immunosuppressants (thiopurines, methotrexate), biological drugs (anti-TNF, anti-integrin, and anti-IL12/23 monoclonal antibodies), and small molecules (JAK inhibitors, S1P receptor modulators). Patients with an aggressive course of disease and risk factors for poor prognosis should be treated with biological therapy early. At the same time, conventional immunomodulators should be used in those with a milder course of disease in the absence of risk factors. Key points Challenges in treating IBD patients include choosing effective yet safe drugs and preventing or overcoming the loss of response.