The monoclonal anti-TNF Infliximab has been a mainstay in the treatment of severe Inflammatory Bowel Diseases, especially Crohn's. But it has to be given as an infusion, and is often associated with the development of neutralising antibodies with chronic use.
This head-to-head study shows that at least one other monoclonal anti-TNF (Adalimumab) is just as effective. Being subcutaneous, it commends itself to self-administration.
For patients with severe Crohn's Disease who fail to respond adequately to anti-TNF biologics, Ustekinumab (anti-IL12/23) represents an important and promising development. IL17 targeting, originally thought to be promising given that it is a key cytokine in mucosal immunity, is pretty dead in the water when treatment of Spondyloarthritis with Secukinumab (anti-IL17A) was associated with cases of Crohn's development or aggravation.
The icing on the cake is that Ustekinumab is, as biologics go, exceedingly safe.
Tofacitinib, the "designer steroid" so far FDA-approved for only Rheumatoid Arthritis, scores yet another success for the treatment of Ulcerative Colitis. Its off-label use in other autoimmune conditions, with late-stage positive trial results or even anecdotal case reports, will likely increase.