Biological therapy refers to the use of customized drugs to specifically target immune mediators or genetic diseases. Even for unknown cause disease, molecules involved in the disease process have been identified, and can be targeted for biological therapy; many of these molecules, which are mainly cytokines, are directly involved in the immune system. Biological therapy has found a niche in cancer management, autoimmune disease, and an unknown cause disease that causes symptoms due to immune-related mechanisms.
Inflammatory bowel disease, or IBD, is a collection of systemic diseases involving inflammation of the gastrointestinal tract. IBD includes two (or three) unknown cause illnesses: ulcerative colitis, which attacks only the large intestine; Crohn's disease, which can affect the entire digestive tract; and, indefinite colitis, which consists of inflammation of the large intestine showing the elements of Crohn's disease and ulcerative colitis.
Although the cause of this disease is unknown, genetic, environmental, immune and other mechanisms have been proposed. Of these, the immune system plays a major role in the development of symptoms. With this, various biological therapies have been developed for the treatment of this disease. This has changed the way doctors treat Crohn's disease and ulcerative colitis.
Video Biological therapy for inflammatory bowel disease
Rationale for biological therapy
Prior to the development of biological therapy as a modality for treating IBD, other drugs that modulate the immune system - including 5-aminosalicylates, steroids, azathioprine, and other immunosuppressants - are primarily used in medicine. Patients with Crohn's disease developing complications, including fistulas (= abnormal connections to the intestines) are treated with surgery. Patients with ulcerative colitis who do not respond to medications are still treated with colectomy (colon removal).
However, basic science studies show that there are many cytokines that increase in both Crohn's disease and ulcerative colitis. Crohn's cytokine is a type 1 cytokine ( Th1 ) that includes TNF-, interleukin-2, and interferon. The less convincing ulcerative colitis associated with the production of Th2 cytokines.
Maps Biological therapy for inflammatory bowel disease
Infliximab
The monoclonal infliximab antibody is a human-mouse chimeric antibody for TNF-. It was first used in the treatment of rheumatoid arthritis, and was the first biological agent used in the treatment of IBD. It is also used in the treatment of psoriasis and ankylosing spondylitis. Infliximab has shown significant success in treating Crohn's disease.
Other monoclonal antibodies
Other agents of biological therapy and monoclonal antibodies have not demonstrated as much efficacy in the treatment of IBD. These include etanercept (which is a soluble receptor for TNF) Adalimumab (which is a human recombinant recombinant for TNF) shows effectiveness in patients with moderate to severe Crohn's disease but less than infliximab.However, this provides an advantage in that it is administered by injection subcutaneous as opposed to infliximab, administered by intravenous infusion.
In 2005, two other recombinant drugs were reported to have beneficial effects on moderate to severe Crohn's disease. Certolizumab is the Fab fragment of the human alpha-alpha monophonic anti-TNF antibody attached to polyethylene glycol to increase the half-life in the circulation. Found to have the efficacy of a placebo drug for 10 weeks in the treatment of moderate to severe Crohn disease in one large trial. Natalizumab is an anti-integrin monoclonal antibody that shows utility as induction and maintenance treatment for moderate to severe Crohn's disease. However, it has been associated with progressive multifocal leukoencephalopathy, a normally fatal viral infection of the brain, which may limit its use.
Side effects and concerns
There are concerns about the side effects of monoclonal antibodies, and especially infliximab, but this is rare. Early side effects include the risk of allergic reactions (including life-threatening anaphylaxis), and reactions to infusions. It is often treated with medications administered prior to treatment. Infliximab also carries a worsening risk of infection, and may cause reactivation of old infections, such as tuberculosis. Over time, there is a risk of serum sickness, which is a hypersensitive response to delayed drugs. Slow complications may include multiple sclerosis and lymphoma. Finally, this drug is quite expensive, with maintenance costs ranging from US $ 3000 to $ 8000 per infusion.
The loss of response to infliximab over time is a concern, due to the development of antibodies to infliximab (called human anti-chimeric antibodies, or HACA). This can be reduced by treatment alongside other immunosuppressant drugs (including azathioprine and methotrexate), by maintaining regular infusion schedules, and by giving patients a dose of pre-treatment steroid treatment.
Biological agents can increase the malignancy due to its effect on the immune system.
Research
Gram positive bacteria present in the lumen can be associated with prolonged relapse time for ulcerative colitis.
See also
- Crohn's disease treatment
- The interaction of essential fatty acids
References
Source of the article : Wikipedia
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