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Earlier, customized biologics may improve response, remission in IBD patients
Earlier treatment with biologic agents and immunosuppressants may improve clinical response and remission rates in patients with inflammatory bowel disease, according to recent findings.
Moreover, the researchers said a personalized approach to selecting biologics for patients — taking into consideration clinical factors and inflammatory biomarker concentrations — is advisable.
Researchers reviewed the evolution of biologic treatments for adults and children with IBD and weighed the value of earlier interventions with these agents. Citing various observational studies, subgroup analyses and randomized clinical trials, researchers observed greater rates of clinical remission through earlier introduction of agents such as adalimumab, certolizumab, and infliximab plus azathioprine
The researchers also identified predictors of complex IBD, including antimicrobial antibodies to anti-Saccharomyces cerevisiae, Escherichia coli outer membrane porin C, bacterial flagellin and Pseudomonas fluorescens bacterial sequence I2. They cautioned, however, that some studies contend there is not enough evidence to recommend antibody testing as a prognostic tool.
In the review, the investigators also identified clinical factors that may be associated with poorer response to biologics, including disease duration, burden of inflammatory disease, smoking, age, isolated ileitis and colitis, and previous use of biologics and immunosuppressants.
“Despite current limitations in our ability to identify those individuals who are most likely to benefit from early initiation of biologic agents, we have identified some clinical predictors of response to biologics that may help to guide clinical practice,” the researchers wrote. “It is recommended that … each patient be considered on a case-by-case basis, after careful consideration of individual clinical risk factors for complicated IBD course, their likelihood of response to biologic therapy, their likelihood of drug intolerance, risk aversion, personal preferences for drug therapy, and risk factors that might place them at higher risk of complications related to drug therapy.”
Disclosure: Relevant financial disclosures were not provided by researchers.