Management of Inflammatory Bowel Disease : The Biological Therapies Era

The management of inflammatory bowel disease has developed over the last decade with the increasing use of immunosuppressive therapies and a shift away from corticosteroid reliance. As our understanding of the molecular basis of persistent inflammation in the gut advances new and promising medical therapies to treat inflammatory activity are emerging. Anti-tumour necrosis factor therapies form the most significant strategy so far but the targeting of adhesion molecules and use of growth peptides offer alternative approaches. Targeting other novel pro-inflammatory cytokines such as IL-12p40 also appears to be promising. Despite their high initial cost, biological therapies have the potential to reduce hospitalisation and surgery and improve quality of life. Much of the initial success of biological therapies has been in Crohn’s disease, and use in ulcerative colitis still remains exploratory. We review the biological basis for these potential therapies and the evidence supporting their use focusing particularly on human studies.