Dr. Ghosh’s Observed Future Directions

In the future, patients with moderately to severely active UC for whom conventional therapies are failing will benefit from having the option of either anti-TNF or anti-integrin biologic therapies. Further dose optimization of biologic therapies, therapeutic drug monitoring, and more flexible dosing may improve clinical efficacy in the future.28 The appropriate choice of therapy will depend on patient characteristics, patient preference, route of administration, physician expertise, and cost. In addition, the era of precision medicine will continue to evolve and bring with it the possibility of biomarker-guided therapeutic decisions.29

Whether patients with moderately to severely active UC should have to experience conventional treatment failure prior to becoming eligible for first-line biologics needs further investigation and may not turn out to be the case, given the unfavorable safety profiles of the first-line therapies, corticosteroids and thiopurines.8,30 Future development and availability of subcutaneously administered anti-integrin biologics may further expand the choice and suitability of these therapies as first-line biologics, as patient administration preferences are an important factor in therapeutic choice.31,32 Head-to-head comparison studies investigating effectiveness, safety, and patient preference involving anti-TNF and anti-integrin antibodies are needed.

References

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Bloomgren G, Richman S, Hotermans C, et al. Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med. 2012;366:1870-1880.

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Haanstra KG, Hofman SO, Lopes Estevao DM, et al. Antagonizing the alpha4beta1 integrin, but not alpha4beta7, inhibits leukocytic infiltration of the central nervous system in rhesus monkey experimental autoimmune encephalomyelitis. J Immunol. 2013;190:1961-1973.

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Milch C, Wyant T, Xu J, et al. Vedolizumab, a monoclonal antibody to the gut homing alpha4beta7 integrin, does not affect cerebrospinal fluid T-lymphocyte immunophenotype. J Neuroimmunol. 2013;264:123-126.

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Stallmach A, Schmidt C, Teich N. Vedolizumab for the treatment of ulcerative colitis. Expert Rev Gastroenterol Hepatol. 2016;10:165-175.

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Lv R, Qiao W, Wu Z, et al. Tumor necrosis factor alpha blocking agents as treatment for ulcerative colitis intolerant or refractory to conventional medical therapy: a meta-analysis. PLoS One 2014;9:e86692.

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