Exploring Advances in Inflammatory Bowel Disease Treatment

Guest Editors: Stephen B. Hanauer, MD and Alvaro A. Pineda, MD

Although decades of clinical experience in IBD management has led to approaches for achieving the induction and maintenance of remission-traditional treatment options include aminosalicylates, corticosteroids, immunosuppressive drugs (e.g., azathioprine, 6-mercaptopurine, methotrexate, cyclosporin), and antibiotics-the disease in many patients remains refractory to conventional medical treatment. Unfortunately, many of these approaches have a slow onset of action and/or are associated with pronounced side effects, often necessitating the discontinuation of treatment. Moreover, many patients do not respond to these drugs on a long-term basis.

Significant progress in our understanding of the pathogenesis of IBD has led research toward identifying targets within the inflammation cascased. The novel biological agent infliximab, a monoclonal antibody directed against tumor necrosis facrot, is approved in the United States for the treatment of Crohn's disease (CD) and ulcerative colitis (UC), and several other biological agents are in clinical trials. In addition, like the more traditional therapies, biological agents are associated with toxicity and side effects.

Leukocytes can release a cascade of proinflammatory cytokines and are therefore implicated in the inflammatory process. The number of activated granulocytes and monocytes/macrophages has been found to be elevated in the peripheral blood and cucosa of IBD patients when compared with healthy controls. Extracorporeal leukocytapheresis, which filteres activated leukocytes from peripheral blood, may be a potential adjunct or alternative to drug regimens that are commonly used to treat IBD, especially for those patient who are resistant or cannot toleration traditional therapies. In Japan and Europe, twosuch devices are commercially available for the treatment of IBD and other autoimmune diseases, including rheumatoid arthritis. Furthermore, unlike other more traditional drug regimens that are used in the treatment of IBD, leukocytapheresis is associated with an excellent safety and tolerability profile. This is especially important for patients who are unable to tolerate the side effects associated with conventional therapies.

This supplement to Inflammatory Bowel Diseases is base on a series of presentations made at a meeting held on October 29, 2004, entitled Exploring Advances in Inflammatory Bowel Disease Treatment. This meeting was held in conjunction with the American College of Gastroenterology's annual meeting, and was sponsored by Otsuka America Pharmaceutical, Inc. Below is a link to the articles in this supplement.

Inflammatory Bowel Disease: Epidemiology, Pathogenesis, and Therapeutic Opportunites (Hanauer, 2006)

Developments in the Apheresis Procedure for the Treatment of Inflammatory Bowel Disease (Pineda, 2006)

Preliminary Data on the Use of Apheresis in Inflammatory Bowel Disease (Sandborn, 2006)

updated 5/13/08