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Biologics Better for Healing of Mucosal Lining in Crohn’s, Ulcerative Colitis

NEW YORK — Meaningful progress has been made in reducing symptoms for Crohn's disease and ulcerative colitis but, overall, healing the mucosal lining of the intestine has been less successful, according to a new study.

The report, published in the journal Alimentary Pharmacology & Therapeutics, notes that, to put off surgery for these patients, the goal of treatment needs to shift toward mucosal clearing rather than just symptom relief.

A recent analysis of clinical trials led by Montefiore Medical Center researchers indicates that anti-tumor necrosis factor α (anti-TNF) agents such as infliximab and adalimumab are helping to reach that goal.

The systematic review examined mucosal healing as an endpoint of immunosuppressives, anti-tumor necrosis factor α (anti-TNF) or anti-integrin monoclonal antibody therapy for moderate-to-severe Crohn’s disease or ulcerative colitis.

Results indicate that the biologics are much more effective than placebo at maintaining mucosal healing in Crohn's disease — 28% versus 1%, with an odds ratio of 19.71. In ulcerative colitis, meanwhile, anti-TNFs and anti-integrins were more effective than placebo for inducing (45% vs. 30%) and maintaining mucosal healing (33% vs. 18%).

For the meta-analysis, 12 randomized controlled trials were included, with duration of follow-up of 6-12 weeks for induction and 32-54 weeks for maintenance trials.

“Anti-TNF and anti-integrin biological agents are effective in inducing mucosal healing in UC with adalimumab being inferior to infliximab or combination therapy. Infliximab and adalimumab were similar in CD,” researchers wrote.

Study authors call the results encouraging, but suggest much more needs to be done to achieve 100% healing in inflammatory bowel disease patients.

"As we are entering the era where we anticipate there will be many new treatments, each targeting inflammation differently, it is also important to understand the relative efficacy of these therapies in achieving our goal of mucosal healing to appropriately position them in our treatment algorithms," explained senior author Ashwin Ananthakrishnan, MBBS, MPH.