The Role of Early Biologic Therapy in Inflammatory Bowel Disease

Over the last 20 years, we’ve witnessed a dramatic shift in inflammatory bowel disease (IBD) management due to the introduction of targeted biologic therapies.

Advancements in these novel biologic therapies is making it possible for doctors and patients to change treatment goals from merely eliminating symptoms to possibly obtaining disease control with endoscopic and clinical remission.

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The Efficacy of Early Biologic Therapy for IBD

Most of the research available involves the early use of biologics, specifically those targeting tumor necrosis factor-alpha (anti-TNF) in patients with Crohn’s Disease (CD). 

Recent evidence suggests that introducing biologic agents in treating early disease improves patient outcomes and can even help slow down or prevent disease progression, reducing the need for surgery due to irreversible bowel damage.

Most IBD disease management strategies currently consider biologic medications as a “step-up” therapy. This means administering them only becomes a viable option after traditional medicines, including corticosteroids, mesalamine, and thiopurines, fail.

However, as our knowledge of biologic therapy grows, we find increasing evidence that introducing biologics before the failure of traditional treatments allows for optimal outcomes in patients with moderate to severe Crohn’s disease.

Data from different studies and clinical trials show superior clinical outcomes in patients who received biologic therapies such as infliximab, adalimumab, and certolizumab early on. For example, researchers found a 15% improvement in remission rates for patients who started adalimumab treatment within the first two years of diagnosis compared to those who began biologic therapy after five years.

However, the window of opportunity where early biological drug introduction can significantly alter disease progression is unique for each patient, so close interaction between doctors and patients is crucial.

More Findings on The Benefits of Early Biologic Therapy

Early use of anti-TNF therapy can provide a significantly higher response rate than the traditional “step-up” approach, which can result in lower corticosteroid use, reduced loss of response, and fewer surgeries.

Researchers also found decreased hospitalization rates in CD patients who received early anti-TNF within three years of diagnosis. Another study revealed that Crohn’s disease patients treated with immunomodulators or anti-TNF agents within two years of diagnosis had a reduced risk of developing new bowel strictures suggesting that introducing biologic therapy early in the disease progression can help reduce structural bowel damage.

Which Patients Benefit the Most from Early Biologic Therapy

Inflammatory Bowel Disease (IBD) has a highly variable disease course. Because of this, early biologic treatment may not be advisable for all patients.

Early treatment with biologic drugs aims to alter the disease progression and prevent future complications. Because of this, top-down disease management applies to patients with moderate to severe disease and not those with mild manifestations.

Therefore, physicians must predict which patients are at risk of progressing to disabling disease and would benefit the most from early biologic treatment.

As more biologic agents become available, the IBD treatment standard could continue to shift from the conventional “step-up” approach towards a “top-down” early intervention strategy. As we advance towards a new disease management standard, Altus Biologics will continue to support physicians and patients, making these medications more accessible.