The advent of monoclonal antibody therapies has revolutionised inflammatory bowel disease (IBD) treatment and delivered great benefits to patients. The optimal use of this class of drugs requires careful management and a clear understanding of their properties. In this review article, we consider how to maximise the benefit of our most novel biological agents, vedolizumab and ustekinumab. For each agent, we consider practical aspects including dose flexibility, evidence for use in combination with a conventional immunomodulator and the potential role of therapeutic drug monitoring. We also address positioning of the various mechanisms and agents in treatment algorithms as well as important aspects of managing patients receiving monoclonal antibodies, such as disease reassessment. Finally, we look ahead to the future of monoclonal antibodies, where not only have biosimilars increased the number of agents available but there are also a range of novel mechanisms currently in late phase clinical trials.
- iInflammatory bowel disease
- ulcerative colitis
- Crohn’s disease
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AGT and GC contributed equally.
Contributors AGT, GC, PMI and MAS were responsible for planning the content and structure of the article. AGT, GC and MAS drafted the manuscript, which PMI and MAS critically reviewed and revised.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PMI: Advisory fees: Abbvie, Warner Chilcott, Takeda, MSD, Vifor Pharma, Pharmacosmos, Topivert, Genentech, Hospira, Samsung Bioepis; Lecture fees: Abbvie, Warner Chilcott, Ferring, Falk Pharma, Takeda, MSD, Johnson and Johnson, Shire. Financial support for research: MSD, Takeda. MAS: Advisory fees: Hospira, Takeda, Janssen; Lecture fees: Hospira, Takeda, MSD, Janssen, Falk.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.