People with inflammatory bowel disease rely on medication to keep them feeling well. Because of the complexity of IBD, knowing what medication will work is often accomplished by trial and error.
Even then, many patients will find success with one medication for many years until the medication stops working for them.
The exciting news is that research is helping us better understand IBD, and has led to many new drugs in development which are now becoming available to patients.
This week the Food and Drug Administration approved Entyvio (vedolizumab) for treatment of ulcerative colitis and Crohn’s disease. Entyvio is approved for those whose conditions do not adequately respond to other therapies. If medications such as corticosteroids, immunomodulators, or tumor necrosis factor blockers have not worked for UC and CD patients, Entyvio is an available possible solution.
Most of the biologic drugs currently on the market for treating IBD all work the same way — by blocking the TNF alpha signaling molecule. These include Remicade, Humira, and Cimzia. They work for a lot of people, but 40 percent of patients have little benefit and need medications with a different mechanism of action.
The new drugs in development for treating IBD fall into three different categories — anti-adhesion molecule therapy, anti-IL 23 therapy, and JAK inhibitors. All have different mechanisms of action to help manage the symptoms of IBD.
Immune suppression where it counts
Anti-adhesion therapies block the ability of the white blood cells to adhere specifically to blood vessels in the gut, reducing the potential for intestinal inflammation. The first drug in this class is the recently approved vedolizumab.
Unlike drug therapies that suppress the immune system in the entire body, anti-adhesion therapies are designed to be gut-specific, and appear to lower the risk of infections compared to current anti-TNF therapies.
New job for current drug
Anti-IL 23 therapy blocks a specific signaling molecule that can lead to inflammation. This is a different mechanism than the one used by anti-TNF drugs so patients who don’t benefit from Remicade, Humira, and Cimzia often do well on anti-IL 23 therapy.
One of the current drugs in this class being tested for Crohn’s disease, ustekinumab, is already FDA approved to treat psoriasis.
Roadblock to inflammation
Drugs known as JAK inhibitors slow down inflammation in a number of diseases by blocking multiple signaling molecules that activate white blood cells. The JAK molecule signals activation in a number of pathways that turn on white blood cells.
Blocking several of these pathways can provide broad control of inflammation. One drug being tested for treating IBD is already FDA approved and on the market for treatment of rheumatoid arthritis.
Time will tell which class of medicine is most effective and most safe. It may be that different medications work well for different people. The U-M is participating in the active clinical trials for these medications which gives our patients access to drugs for treating IBD before they are commercially available and contributes to advances in treatment.
Researchers are also working on diagnostic testing for IBD that will tell us more details about a person’s IBD. IBD involves more than 160 genes, which means there are at least that many “types” of IBD.
Being able to better categorize someone’s disease could allow us to pick the best therapy for each patient, rather than trying several therapies before we find which one works best.
Take the next step:
- Learn more about the University of Michigan Crohn’s Disease and Ulcerative Colitis program.
- Watch the IBD School Video Series that explains myths of the disease, its causes and treaments.
- Learn more about IBD clinical trials underway at the University of Michigan.
Dr. Peter Higgins is a gastroenterologist at the University of Michigan Health System and the IBD editor for the American Journal of Gastroenterology. His research focuses on inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis. He is a member of the AGA IBD Quality Measures Committee, and has participated in the development of national guidelines for high quality IBD care.
The University of Michigan Digestive and Liver Health services is one of the largest programs in the country, providing prevention, diagnosis and treatment of diseases involving the gastrointestinal tract and liver. Our 60-plus physicians are experts in the diagnosis and treatment of all diseases of the gastrointestinal system.