Expert Opinion on Emerging Drugs vol:12 issue:1 pages:49-59
The advent of the anti-TNF agent infliximab has dramatically changed our concept of treating refractory inflammatory bowel disease, particularly Crohn's disease. Although infliximab has proven to induce clinical response and remission with rapid onset of mucosal healing, to spare steroids, to improve perianal disease and to increase quality of life, there is an ongoing debate about optimizing infliximab therapy and a clear unmet medical need for patients losing their response to this agent. Novel anti-TNF agents, mostly more humanized monoclonal antibodies, with subcutaneous administration, have shown efficacy and are in advanced stages of clinical development. Compounds targeted at alternative pathways in the immune cascade are not expected to enter the market soon. Promising novel therapeutic classes include the anti-IL-12/23 and anti-IFN-gamma agents and the selective adhesion molecule inhibitors. Most of the biologic therapies, including anti-TNF agents, are aimed at crucial pathways in the immune system on the crossroads between immune pathology and host defense. Therefore, long-term benefit to risk profiles need to be established for all novel drugs.