Background: Combining immunosuppressors has been proposed as a strategy to enhance treatment efficacy in Inflammatory Bowel Disease (IBD). Aim: To summarize current evidence on combinations of targeted therapies with traditional immunosuppressors or with other targeted therapies. Methods: A literature search on PubMed and Medline databases was performed to identify relevant articles. Results: Current evidence supports that the combination of infliximab and thiopurines is more effective than monotherapy with both agents in inducing remission in Crohn's Disease and Ulcerative colitis. Data on other combinations of other biologics and traditional immunosuppressors is lacking or show conflicting results. Vedolizumab seems a potentially effective maintenance regimen after calcineurin inhibitors-based rescue therapy in acute severe ulcerative colitis, as an alternative to thiopurines. Dual Targeted Therapy, which is the combination of 2 targeted therapies, might be a reasonable choice in patients with concomitant IBD and extraintestinal manifestations, or in patients with medical-refractory IBD who lack valid alternatives. Combinations with thiopurines are associated with an increased risk of infections and lymphoma. Data on other combinations is scarcer, but no specific safety issue has emerged so far. Conclusions: Combination therapies seem to be effective in selected patients, with an overall acceptable safety profile.

Combination therapy in inflammatory bowel disease – from traditional immunosuppressors towards the new paradigm of dual targeted therapy

Onali S.;
2021-01-01

Abstract

Background: Combining immunosuppressors has been proposed as a strategy to enhance treatment efficacy in Inflammatory Bowel Disease (IBD). Aim: To summarize current evidence on combinations of targeted therapies with traditional immunosuppressors or with other targeted therapies. Methods: A literature search on PubMed and Medline databases was performed to identify relevant articles. Results: Current evidence supports that the combination of infliximab and thiopurines is more effective than monotherapy with both agents in inducing remission in Crohn's Disease and Ulcerative colitis. Data on other combinations of other biologics and traditional immunosuppressors is lacking or show conflicting results. Vedolizumab seems a potentially effective maintenance regimen after calcineurin inhibitors-based rescue therapy in acute severe ulcerative colitis, as an alternative to thiopurines. Dual Targeted Therapy, which is the combination of 2 targeted therapies, might be a reasonable choice in patients with concomitant IBD and extraintestinal manifestations, or in patients with medical-refractory IBD who lack valid alternatives. Combinations with thiopurines are associated with an increased risk of infections and lymphoma. Data on other combinations is scarcer, but no specific safety issue has emerged so far. Conclusions: Combination therapies seem to be effective in selected patients, with an overall acceptable safety profile.
2021
Biologics
Calcineurin inhibitors
Combination therapy
Crohn's Disease
Thiopurines
Ulcerative colitis
Biological Factors
Humans
Infliximab
Colitis, Ulcerative
Crohn Disease
Inflammatory Bowel Diseases
File in questo prodotto:
File Dimensione Formato  
Autoimmunity rev Privitera et al.pdf

Solo gestori archivio

Dimensione 2.29 MB
Formato Adobe PDF
2.29 MB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11584/327575
Citazioni
  • ???jsp.display-item.citation.pmc??? 14
  • Scopus 41
  • ???jsp.display-item.citation.isi??? 35
social impact