47th Annual Gastroenterology Update: Biologic Therapies for Inflammatory Bowel Disease, Part 2

Cleveland, OH— Ahmed Kandiel, MD, MPH at the Cleveland Clinic concluded his lecture, Which Patient/Which Biologic, by reviewing the results of a recently published meta-analysis which examined the risks and benefits of biologic therapy for patients with moderate to severe IBD.

“There are no head to head trials comparing anti-TNFα therapies to each other or to natalizumab,” Kandiel exclaimed, adding specific guidelines for anti-TNFα therapy for patients who have not taken an anti-TNFα agent needs to be developed. “However, there are many correct approaches to treating patients with moderate-to-severe IBD,” he said. Kandiel said physicians should always confirm active inflammation before changing therapy and rule out other causes of symptoms, such as superimposed infections, Celiac disease, thyroid disease, or irritable bowel syndrome.

Are All Biologics Created Equal?

Kandiel offered his perspective on a meta-analysis published earlier this year by Alexander Ford, MD, and colleagues. Dr Ford’s systematic review and meta-analysis was the first comprehensive review of all the biologic agents, Kandiel said. The meta-analysis included trials recruiting adults with active or quiescent Crohn’s disease (CD) or ulcerative colitis (UC) and comparing biological therapies (anti-TNFα or natalizumab) with placebo. The authors set a specific timeframe for outcome assessment: up to 4 months for induction of remission trials and greater than 6 months for prevention of relapse trials. In total, 27 peer-reviewed articles were eligible for inclusion.

Results from the meta-analysis showed biologics in IBD more efficacious than placebo in: inducing remission in moderate-to-severe CD; preventing relapse in quiescent CD; inducing remission in moderate to severe UC; and healing fistulizing CD. For induction of remission of CD, infliximab, natalizumab, and adalimumab have the most evidence for use based on this analysis, Kandiel said. He noted the greatest effect of biologics was in preventing relapse of CD after remission, adding there is less data for biologics in healing fistulizing CD.

If you have a patient with luminal CD who needs biologic therapy, which biologic agent would you chose, asked Kandiel. “It is like flipping a coin,” answered Kandiel. The answer is up to the physician after having a discussion with the patient. “The data seem to indicate the biologics are equally effective.”