David Fudman, Ryan A McConnell, Christina Ha, Siddharth Singh
{"title":"Modern Advanced Therapies for Inflammatory Bowel Diseases: Practical Considerations and Positioning.","authors":"David Fudman, Ryan A McConnell, Christina Ha, Siddharth Singh","doi":"10.1016/j.cgh.2024.06.050","DOIUrl":null,"url":null,"abstract":"<p><p>The therapeutic armamentarium for management of inflammatory bowel diseases (IBD) has expanded dramatically in the last 5 years, with the introduction of several medications with different mechanisms of action. These include the oral small molecule drugs Janus kinase inhibitors (JAKi, including upadacitinib approved for Crohn's disease [CD] and ulcerative colitis [UC], as well as tofacitinib, approved for UC) and sphingosphine 1-phosphate receptor (S1PR) modulators (ozanimod and etrasimod, both approved for UC), as well as biologic agents like selective interleukin-23 (IL23) antagonists (risankizumab approved for CD, and mirikizumab approved for UC). The efficacy and safety of these therapies vary. In this review, we discuss practical use of these newer advanced therapies focusing on real-world effectiveness and safety data, dosing and monitoring considerations, as well as special situations for their use such as pregnancy, co-morbid immune-mediated disease, use in hospitalized patients with acute severe UC, and in the perioperative setting. We also propose our approach to positioning these therapies in clinical practice, relying on careful integration of the medication's comparative effectiveness and safety in the context of an individual patient's risk of disease- and treatment-related complications and preferences.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6000,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cgh.2024.06.050","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
The therapeutic armamentarium for management of inflammatory bowel diseases (IBD) has expanded dramatically in the last 5 years, with the introduction of several medications with different mechanisms of action. These include the oral small molecule drugs Janus kinase inhibitors (JAKi, including upadacitinib approved for Crohn's disease [CD] and ulcerative colitis [UC], as well as tofacitinib, approved for UC) and sphingosphine 1-phosphate receptor (S1PR) modulators (ozanimod and etrasimod, both approved for UC), as well as biologic agents like selective interleukin-23 (IL23) antagonists (risankizumab approved for CD, and mirikizumab approved for UC). The efficacy and safety of these therapies vary. In this review, we discuss practical use of these newer advanced therapies focusing on real-world effectiveness and safety data, dosing and monitoring considerations, as well as special situations for their use such as pregnancy, co-morbid immune-mediated disease, use in hospitalized patients with acute severe UC, and in the perioperative setting. We also propose our approach to positioning these therapies in clinical practice, relying on careful integration of the medication's comparative effectiveness and safety in the context of an individual patient's risk of disease- and treatment-related complications and preferences.
期刊介绍:
Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion.
As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.