Dr Gaddam is a final year student of MSc Internal medicine from the University of Edinburgh, UK. He is presently working as a General Physician in Noor Al Ahli medical center, Al Ain, UAE.
Inflammatory bowel disease (IBD), a complex, severe, chronic inflammatory disorder affecting the gastrointestinal tract, can fluctuate and resist standard therapy. IBD research, biomarker identification, pathophysiology and molecular mechanisms exploration have led to prospective therapy targets that can alter the disease’s early course. Exploring newer, more effective medicines that reduce flares, induce rapid remission, and improve care is important.
Non-biologic medicines alleviate symptoms but do not modify disease progression. Biologics induce and maintain remission of both Crohn’s disease and ulcerative colitis.3 Drugs targeting different stages of disease process to halt the progression have been identified. Novel therapy targets include improving epithelial barrier function, inhibiting pro-inflammatory cytokinin, limiting inflammatory cell trafficking, and boosting regulatory T cell function.
Newer Therapeutic targets
Currently, successful IBD treatments target TNF-α, including infliximab, adalimumab, certolizumab pegol, and golimumab. Vedolizumab, an α4β7 integrin blocker, affects gut T-cell homing. JAK inhibitor tofacitinib and IL-12/23 p40 blocker ustekinumab interrupt effector T cell differentiation. IL-23 p19 subunit inhibitor risankizumab and lymphocyte homing modulator ozanimod were recently approved. selective JAK inhibitor filgotinib and TLR9 agonist cobitolimod are nearing approval.2 Upadacitinib, an FDA-approved JAK Kinase inhibitor, is another novel Ulcerative Colitis (UC) therapy. UC treatment with fecal microbiota transplantation is promising, but many issues remain.
Newer, better, and safer IBD treatments are needed. Treat to target, early intervention, biomarker identification, personalization, and disease prevention are new therapy approaches. Novel medicines, microbiome consumption, and stem cells targeting disease pathways in IBD pathogenesis enable new therapeutic targets.