Comparative Role of Anti-TNF Agents versus IL-12/23 Inhibitors in Inflammatory Bowel Disease: An Updated Review
DOI:
https://doi.org/10.24871/253202457-61Keywords:
Anti-TNF drugs, crohn's disease, IL-12/23 inhibitors, inflammatory bowel disease, ulcerative colitisAbstract
Treatments for Crohn's Disease (CD) and Ulcerative Colitis (UC), two conditions that fall under the umbrella of Inflammatory Bowel Disease (IBD), must be both safe and effective. This review compares the effectiveness and safety of anti-TNF agents and IL-12/23 inhibitors, specifically in the context of IBD management. Randomized controlled trials (RCTs), observational studies, and meta-analyses involving adult IBD patients were all included in the review. Anti-TNF agents (infliximab and adalimumab) were shown to significantly improve clinical remission rates and reduce complications, particularly with early intervention. However, these agents were associated with adverse effects such as infections and autoimmune reactions. IL-12/23 inhibitors, particularly risankizumab, showed superior efficacy in achieving and maintaining remission with a better safety profile. The findings prove that IL-12/23 inhibitors might be more effective for patients who are unresponsive to anti-TNF therapies. In conclusion, both anti-TNF agents and IL-12/23 inhibitors effectively manage IBD, with IL-12/23 inhibitors offering a favorable safety profile. Early intervention and personalized treatment strategies are significant for optimizing patient outcomes. It will take additional research to validate these results and improve treatment strategies.ÂReferences
Almradi A, Hanzel J, Sedano R, et al. Clinical Trials of IL-12/IL-23 Inhibitors in Inflammatory Bowel Disease. BioDrugs. 2020;34(6):713-21.
Ward D, Nyboe Andersen N, Gørtz S, et al. Tumor Necrosis Factor Inhibitors in Inflammatory Bowel Disease and Risk of Immune Mediated Inflammatory Diseases. Clin Gastroenterol Hepatol. 2024;22(1):135-143.e8.
Feagan BG, Sandborn WJ, D’Haens G, et al. Induction therapy with the selective interleukin-23 inhibitor risankizumab in patients with moderate-to-severe 'Crohn's disease: a randomized, double-blind, placebo-controlled phase 2 study. Lancet. 2017;389(10080):1699-709.
Feagan BG, Panés J, Ferrante M, et al. Risankizumab in patients with moderate to severe 'Crohn's disease: an open-label extension study. Lancet Gastroenterol Hepatol. 2018;3(10):671-80.
Ferrante M, Panaccione R, Baert F, et al. Risankizumab as maintenance therapy for moderately to severely active Crohn's disease: results from the multicentre, randomized, double-blind, placebo-controlled, withdrawal phase 3 FORTIFY maintenance trial. Lancet. 2022;399(10340):2031-46.
D’Haens G, Vermeire S, Lambrecht G, et al. Increasing Infliximab Dose Based on Symptoms, Biomarkers, and Serum Drug Concentrations Does Not Increase Clinical, Endoscopic, and Corticosteroid-Free Remission in Patients With Active Luminal 'Crohn's Disease. Gastroenterology. 2018;154(5):1343-1351.e1.
Colombel J, Reinisch W, Mantzaris GJ, et al. Randomized clinical trial: deep remission in biologic and immunomodulator naïve patients with 'Crohn's disease – a SONIC post hoc analysis. Aliment Pharmacol Ther. 2015;41(8):734-46.
Schreiber S, Reinisch W, Colombel J, et al. Subgroup analysis of the placebo-controlled CHARM trial: Increased remission rates through 3 years for adalimumab-treated patients with early Crohn's disease. J Crohns Colitis. 2013;7(3):213-21.
Safroneeva E, Vavricka SR, Fournier N, et al. Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in 'Crohn's disease. Aliment Pharmacol Ther. 2015;42(8):977-89.
Vuyyuru SK, Solitano V, Hogan M, et al. Efficacy and Safety of IL-12/23 and IL-23 Inhibitors for 'Crohn's Disease: Systematic Review and Meta-Analysis. Dig Dis Sci. 2023;68(9):3702-13.
Perrier C, Rutgeerts P. Cytokine blockade in inflammatory bowel diseases. Immunotherapy. 2011;3(11):1341-52.
Wong U, Cross RK. Expert opinion on interleukin-12/23 and interleukin-23 antagonists as potential therapeutic options for the treatment of inflammatory bowel disease. Expert Opin Investig Drugs. 2019;28(5):473-79.
Danese S, Peyrin-Biroulet L. Evolution of IL-23 Blockade in Inflammatory Bowel Disease. J Crohns Colitis. 2022;16(Supplement_2).
Danese S, Peyrin-Biroulet L. Are all the IL-23 blockers the same in inflammatory bowel disease? Nat Rev Gastroenterol Hepatol. 2024.
Fiorillo C, Schena CA, Quero G, et al. Challenges in Crohn's disease management after gastrointestinal cancer diagnosis. Cancers. 2021;13:574.
Dipasquale V, Romano C. Genes vs environment in inflammatory bowel disease: an update. Expert Rev Clin Immunol. 2022;18:1005-13.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).