Treatment for IBD has traditionally centered on the use of antibiotics, aminosalicylates, corticosteroids and immunomodulators. In the past decade, however, the treatment options available for IBD have expanded to include biologic agents. These agents have had a dramatic impact on the way physicians treat their patients and therapeutic strategies for IBD are likely to be markedly altered by their introduction to the therapeutic armamentarium. The biologic agents currently available for the treatment of IBD target the pro-inflammatory cytokine tumor necrosis factor and the mechanisms involved in leukocyte migration. In this Focus issue, leaders in the field provide an update on the current status of biologic therapies for IBD and set the stage for developments in the near and distant future. Encompassing discussion of the potential for disease modification, therapeutic rationale and requisite evidence, safety, pharmacoeconomics, and future targets, this Focus provides a valuable and cutting-edge resource for clinicians and researchers.

An NPG library of relevant Reviews, Editorials, News and Views. Reviews, Original research and Case Studies is also provided.



REVIEWS

The potential for disease modification in Crohn's disease

Gert Van Assche, Séverine Vermeire & Paul Rutgeerts

doi:10.1038/nrgastro.2009.220

Nature Reviews Gastroenterology & Hepatology 7, 79-85 (2010)

Treatment of patients with Crohn's disease to delay the natural evolution of the disease and avoid the development of complicated disease as well as the need for hospitalization and surgery is desirable. Gert Van Assche and colleagues discuss the disease-modifying potential of immunosuppressive and anti-tumor necrosis factor therapies, especially when given as early, aggressive therapy.

Top-down therapy for IBD: rationale and requisite evidence

Geert R. D'Haens

doi:10.1038/nrgastro.2009.222

Nature Reviews Gastroenterology & Hepatology 7, 86-92 (2010)

Early treatment of Crohn's disease with immunomodulators and anti-TNF agents is associated with better clinical outcomes than standard therapy, but these drugs may have serious adverse effects and are not suitable for all patients. The author reviews current clinical evidence and proposes a strategy for adequate selection of patients for top-down therapy of IBD.

Optimizing the safety of biologic therapy for IBD

Shanika de Silva, Shane Devlin & Remo Panaccione

doi:10.1038/nrgastro.2009.221

Nature Reviews Gastroenterology & Hepatology 7, 93-101 (2010)

Despite the widespread use of biologic therapy for IBD, safety concerns still exist. To realize the full potential of these therapies it is important to select appropriate patients for therapy and to optimize the delivery of these agents, thus maximizing their effectiveness. At the same time it is important to adopt strategies before and during treatment that minimize the occurrence of adverse effects. This Review outlines the adverse events associated with biologic therapies, and gives recommendations on how to reduce the risk of these events.

The pharmacoeconomics of biologic therapy for IBD

Russell D. Cohen

doi:10.1038/nrgastro.2009.232

Nature Reviews Gastroenterology & Hepatology 7, 103-109 (2010)

IBD is associated with a young age at onset and normal life expectancy, which results in a lifetime accrual of disease-related costs. This Review discusses the economic impact of biologic therapy on direct costs of IBD, such as hospitalizations and surgeries, and indirect costs, such as those related to disability and loss of productivity.

Future biologic targets for IBD: potentials and pitfalls

Gil Y. Melmed & Stephan R. Targan

doi:10.1038/nrgastro.2009.218

Nature Reviews Gastroenterology & Hepatology 7, 110-117 (2010)

IBD treatment has evolved towards biologic therapy, which seeks to target specific immune and biochemical abnormalities at the molecular and cellular level. Improved understanding of the pathogenesis of IBD has suggested future drug biologic targets, which are currently being investigated. This Review article discusses the potentials and pitfalls of biologic therapy for IBD as this field advances at a rapid pace

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