Beyond infliximab: Other anti-tnf therapies for ulcerative colitis

The era of biologic therapy for inflammatory bowel disease was launched in 1998 with the Food and Drug Administration’s approval of infliximab (IFX), a chimeric monoclonal antibody to tumor necrosis factor-alpha (TNF-α), for Crohn’s disease (CD). However, it was not until 2005, after the results of several open-label clinical studies and of the ACT1 and ACT2 trials of IFX for treatment of moderate to severe ulcerative colitis (UC), that this agent was approved for therapy of UC. In a recent meta-analysis, it was estimated that the number of patients with UC needed to treat with IFX to achieve one remission was only four. However, as experience with using anti-TNF-α agents in CD has shown, the development of loss of response or intolerance to an initial anti-TNF-α agent, partly due to immunogenic effects, is a real problem and having other choices for blocking TNF-α is advantageous. Since 2012, the FDA has approved two other anti-TNF-α antibodies, adalimumab and golimumab, for the treatment of UC. In this chapter, we will review the evidence supporting the use of these agents for UC therapy.