Review
Copyright ©The Author(s) 2018.
World J Gastroenterol. Aug 28, 2018; 24(32): 3567-3582
Published online Aug 28, 2018. doi: 10.3748/wjg.v24.i32.3567
Table 1 Currently approved biologic treatments for inflammatory bowel diseases[16,117,118]
MedicationRoute of administration (IV, SC, PO)Approved dose
InfliximabIVInduction: 5-10 mg/kg (weeks 0, 2, and 6) Maintenance: 5-10 mg/kg every 4-8 wk
AdalimumabSCInduction: 160 mg (week 0), 80 mg (week 2) Maintenance: 40 mg every 7-14 d
GolimumabSCInduction: 200 mg (week 0), 100 mg (week 2) Maintenance: 100 mg every 4 wk
CertolizumabSCInduction: 400 mg (weeks 0, 2, and 4) Maintenance: 400 mg every 4 wk
VedolizumabIVInduction: 300 mg (weeks 0, 2, and 6) Maintenance: 300 mg every 4-8 wk
UstekinumabIV SCInduction: < 55 kg: 260 mg 55-85 kg: 390 mg > 85 kg: 520 mg Maintenance: 90 mg every 8 wk
Table 2 Biologic agents which have demonstrated efficacy in inflammatory bowel diseases and rheumatology
Mechanism of actionUCCD2FistulizationAnkylosing SpondylitisPsoriasis
Anti-TNF
1Infliximab[20,22,51,119]Chimeric monoclonal antibodyxxxxx
Adalimumab[26,28,54,120,121]Fully human monoclonal antibodyxxxxx
Certolizumab[31,122,123]Pegylated humanized monoclonal antibody Fab' fragmentx+/-xx
Golimumab[57,122,124]Fully human monoclonal antibodyxxx
Anti-integrin
4Natalizumab[39]Chimeric monoclonal antibody against α4 integrinx
3Vedolizumab[46,96]Chimeric monoclonal antibody against α4β7 integrinxx+/-
Ustekinumab[50,125,126]Fully human monoclonal antibody against P40 sub-unit of IL-12 and IL-23x+/-xx
Table 3 Recommendations for treating to target in Crohn’s disease by the International Organization for the Study of Inflammatory Bowel Diseases[19]
Crohn’s diseaseUlcerative colitis
The consensus target is a combination of:
Clinical/1PRO remission defined as resolution of abdominal pain and diarrhea or altered bowel habits which should be assessed every 3 mo until resolution then 6-12 mo thereafter. and Endoscopic remission2 defined as resolution of ulceration at ileocolonoscopy which should be assessed at 6-9 mo intervals during the active phaseClinical/1PRO remission defined as resolution of rectal bleeding and diarrhea or altered bowel habits which should be assessed every 3 mo until resolution then 6-12 mo thereafter. and Endoscopic remission2 defined as resolution of friability and ulceration at flexible sigmoidoscopy or colonoscopy3 which should be assessed at 3 mo intervals during the active phase
Adjunctive measures of disease activity that may be useful in the management of selected patients but are not a treatment target include:
•Faecal calprotectin•CRP •Faecal calprotectin •Histology
Measures of disease activity that are not a target:
•Histology •Cross-sectional imaging•Cross-sectional imaging