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Review
. 2018 Dec;40(6):446-460.
doi: 10.1080/08923973.2018.1469144. Epub 2018 May 10.

Current, experimental, and future treatments in inflammatory bowel disease: a clinical review

Christian L Hvas  1 , Mia Bendix  1   2 , Anders Dige  1 , Jens F Dahlerup  1 , Jørgen Agnholt  1
Affiliations
Review

Current, experimental, and future treatments in inflammatory bowel disease: a clinical review

Christian L Hvas et al. Immunopharmacol Immunotoxicol. 2018 Dec.

Abstract

Inflammatory bowel diseases (IBDs) may result from dysregulated mucosal immune responses directed toward the resident intestinal microbiota. This review describes the hallmark immunobiology of Crohn's disease and ulcerative colitis as well as therapeutic targets and mechanisms of action for current, experimental, and future treatments in IBD. Conventional therapies include 5-aminosalicylic acid, glucocorticosteroids, thiopurines, and methotrexate. Since 1997, monoclonal antibodies have gained widespread use. These consist of antibodies directed against pro-inflammatory cytokines such as tumor necrosis factor α, interleukin (IL)-12, and IL-23, or anti-homing antibodies directed against α4β7 integrin. Emerging oral therapies include modulators of intracellular signal transduction such as Janus kinase inhibitors. Vitamin D may help to regulate innate and adaptive immune responses. Modulation of the intestinal microbiota, using live microorganisms (probiotics), substrates for the colonic microbiota (prebiotics), or fecal microbiota transplantation (FMT), is in development. Dietary supplements are in widespread use, but providing evidence for their benefit is challenging. Stem cell treatment and nervous stimulation are promising future treatments.

Keywords: Crohn’s disease; Inflammatory bowel disease; antibodies; fecal microbiota transplantation; monoclonal; ulcerative colitis.

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