Gomollón Fernando
Unidad de Enfermedad Inflamatoria Intestinal, Profesor Asociado de Medicina, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, CIBEEHD, Zaragoza, España.
Gastroenterol Hepatol. 2014 Sep;37 Suppl 3:14-21. doi: 10.1016/S0210-5705(14)70079-2.
The way we treat inflammatory bowel disease is rapidly changing. Biologics have accounted for the biggest change in recent years, and they are being used on a more regular basis, on more indications and at earlier stages. However, primary response failure and, above all, secondary response failure and cost represent serious limitations for their use. Combination immunosuppressant therapy, individualization depending on levels and response, increasing compliance and a more suitable choice of cases can all enhance effectiveness. However in many cases, new alternatives will be necessary. Recently, 2 new antibodies have been approved: golimumab is a new option for ulcerative colitis and with another more selective mechanism of action; vedolizumab could be useful for ulcerative colitis as well as Crohn's disease. Ustekinumab is an alternative treatment option for refractory Crohn's disease. In addition to biologics, autologous bone marrow transplants and, anecdotally, the use of immunoglobulins have been suggested as alternatives in some carefully selected cases. Although effective for Clostridium difficile infection, the potential role of fecal transplants in inflammatory bowel disease is still to be determined, without initially observing very promising results. The use of probiotics has not produced significant positive results.
