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Drugs in R & D

, Volume 1, Issue 3, pp 237–244 | Cite as

Promising New Agents for the Treatment of Inflammatory Bowel Disorders

  • Kevin A. Lang
  • Mark A. Peppercorn
Leading Article Section 2: Inflammatory Bowel Disorders

Abstract

A groundswell of therapeutic modalities is presently sweeping through the field of inflammatory bowel disease (IBD), revolutionising the treatment and management of these disorders. At the forefront of newer agents are biological therapies, also referred to as ‘biologics’. These include infliximab (cA2), CDP 571, rhIL-10, ICAM-1 antisense oligonucleotide (ISIS 2302) and opreleukin (rhIL-11).

Among these, infliximab and CDP 571 are perhaps the most promising, particularly in Crohn’s disease. Both are anti-TNFa monoclonal antibody formulations with proven efficacy at doses of 5 mg/kg for inducing remission in patients with moderate to severe refractory Crohn’s disease. Infliximab is beneficial in the treatment of fistulous Crohn’s disease as well. Anti-inflammatory cytokines such as rhIL-10 and opreleukin (rhIL-11) in early reports appear efficacious in Crohn’s disease but not in ulcerative colitis.

Budesonide, a second generation glucocorticoid, in an oral controlled ileal release capsule, is an attractive alternative to prednisone for treating active Crohn’s disease of the distal ileum and proximal colon. Also available as an enema, budesonide’s efficacy approximates that of prednisolone for inducing remission in active distal ulcerative colitis.

Postoperative recurrences of Crohn’s disease are a common clinical scenario. Recently, mesalazine, metronidazole and mercaptopurine have been re-evaluated in the postoperative setting. In the largest postoperative prophylaxis trial, mercaptopurine was superior to both placebo and mesalazine in preventing clinical, endoscopic and radiographic relapses.

Finally, miscellaneous therapies such as transdermal nicotine, nicotine tartrate enemas and topical lidocaine used in pilot studies for ulcerative colitis have shown promise. Case reports of thalidomide and tacrolimus (FK 506) have reported beneficial effects in treating complicated, refractory Crohn’s disease.

Keywords

Ulcerative Colitis Infliximab Budesonide Mesalazine Mercaptopurine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Adis International Limited 1999

Authors and Affiliations

  1. 1.Department of GastroenterologyWilford Hall Medical CenterLackland AFBUSA
  2. 2.Department of MedicineUniversity of Texas Health Science Center, ]San AntonioUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.Center for Inflammatory Bowel DiseaseBeth Israel Deaconess Medical CenterBostonUSA

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