Which Biologics for Crohn & Colitis?

    

    

Doctors newspaper online, 09.07.2019

    

        
        
        

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intestinal inflammation

A binding flowchart for the use of biologics in CED has not been defined yet. A colleague gives tips.

WIESBADEN. In recent years evidence-based guidelines and therapy algorithms have been developed for therapy in CED. In addition to the proven therapeutic options, modern biologics are becoming increasingly important. "In general, a step-up therapy in the sense of a step-up is considered useful," Professor Gerhard Rogler, University Hospital Zurich, recalled at an event sponsored by the Falk Foundation in Wiesbaden.

However, a more aggressive "top-down" therapy is recommended for patients with a high risk of complications. For each patient, an individual risk-benefit assessment is important, taking into account the strengths and risks of the new biologics.

For ulcerative colitis, proven therapies such as 5-ASA preparations, topical and systemic steroids, and immunosuppressants continue to be of value. If these are not enough, today biologics are available, namely the anti-TNF antibodies infliximab, adalimumab and golimumab and the anti-integrin antibody vedolizumab.

In addition to topical and systemic steroids and immunosuppressants such as azathioprine and methotrexate, infliximab adalimumab, vedolizumab and the anti-IL-12 / IL-23 antibody, ustekinumab have been established in Crohn's disease. In addition, tofacitinib is approved as an oral medication in ulcerative colitis.

"These new therapeutic options must be incorporated into the therapy algorithm," says Rogler. But there could not be a simple flowchart for all patients. That would make things too easy for you. In order to be able to make the best decision in individual cases, a profound knowledge of the respective advantages and disadvantages is necessary.

Example: For ulcerative colitis, infliximab is the most effective, but the risk of side effects is higher than for vedolizumab. Therefore, it may be useful to start with vedolizumab as a first-line biologic in a not too severe form of ulcerative colitis, especially if a rapid therapeutic success is necessary and no extra-intestinal manifestations are present.

The same applies to Crohn's disease, whereby extraintestinal manifestations also respond to ustekinumab. (sti)

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