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A.S. Cheifetz, J.D. Feuerstein (eds.), Treatment of Inflammatory
Bowel Disease with Biologics, https://doi.org/10.1007/978-3-319-60276-9_16
Chapter 16
Anti-integrin Agents in IBD: Efficacy and Risk
of Complications
Jimmy K. Limdi and Francis A. Farraye
Introduction
The last two decades have witnessed unprecedented advances in our understanding
of the immuno-pathogenesis of the inflammatory bowel diseases (IBD). Conventional
management until then typically involved the use of broad-spectrum anti-
inflammatory drugs such as aminosalicylates and corticosteroids or immunosup-
pressants such as the thiopurines or methotrexate, often sequentially with the aim of
relieving symptoms and preventing long-term complications [ 1 , 2 ]. The advent of
anti-TNF therapy demonstrating efficacy in the induction and maintenance of
remission, corticosteroid-sparing effects, mucosal healing and reduced rates of hos-
pitalisation and surgery redefined treatment paradigms and definitions of disease
control [ 3 ]. The exciting implications of what can be achieved, through abrogation
of immuno-inflammatory events in the inflamed gut, widened the search for other
agents to combat IBD-associated gut inflammation. Meanwhile, anti-TNF therapy
was not universally effective, with approximately 30–50% of patients being primary
nonresponders with further attrition from secondary loss of response as a result of
intolerance to therapy or through formation of anti-drug antibodies. In addition,
although infrequent, there is a risk of infectious complications attributable to the
non-specific inhibition of TNF-mediated immunologic cascades [ 3 – 6 ].
J.K. Limdi
Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust,
Manchester, BL97TD, UK
Institute of Inflammation and Repair, University of Manchester, Manchester, UK
e-mail: [email protected]
F.A. Farraye (*)
Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine,
85 East Concord Street, Boston, MA, USA
e-mail: [email protected]