A groundswell of therapeutic modalities is presently sweeping through the field of
inflammatory bowel disease (IBD), revolutionising the treatment and management of these disorders. At the forefront of newer agents are
biological therapies, also referred to as 'biologics'. These include
infliximab (cA2),
CDP 571, rhIL-10,
ICAM-1 antisense oligonucleotide (
ISIS 2302) and opreleukin (rhIL-11). Among these,
infliximab and
CDP 571 are perhaps the most promising, particularly in
Crohn's disease. Both are anti-
TNF alpha monoclonal antibody formulations with proven efficacy at doses of 5 mg/kg for inducing remission in patients with moderate to severe refractory
Crohn's disease.
Infliximab is beneficial in the treatment of fistulous
Crohn's disease as well. Anti-inflammatory
cytokines such as rhIL-10 and opreleukin (rhIL-11) in early reports appear efficacious in
Crohn's disease but not in
ulcerative colitis.
Budesonide, a second generation
glucocorticoid, in an oral controlled ileal release
capsule, is an attractive alternative to
prednisone for treating active
Crohn's disease of the distal ileum and proximal colon. Also available as an
enema,
budesonide's efficacy approximates that of
prednisolone for inducing remission in active distal
ulcerative colitis. Postoperative recurrences of
Crohn's disease are a common clinical scenario. Recently,
mesalazine,
metronidazole and
mercaptopurine have been re-evaluated in the postoperative setting. In the largest postoperative prophylaxis trial,
mercaptopurine was superior to both placebo and
mesalazine in preventing clinical, endoscopic and radiographic relapses. Finally, miscellaneous
therapies such as transdermal
nicotine,
nicotine tartrate enemas and topical
lidocaine used in pilot studies for
ulcerative colitis have shown promise. Case reports of
thalidomide and
tacrolimus (
FK 506) have reported beneficial effects in treating complicated, refractory
Crohn's disease.