Dr Patil reviews the latest information on the uses of IL-12/23 inhibitors such as ustekinumab for the management of inflammatory bowel disease.

Seema Patil, MD, is an associate professor of medicine at the University of Maryland School of Medicine in Baltimore, Maryland.

TRANSCRIPT:

Hi. I'm Seema Patil from the Inflammatory Bowel Disease Program at University of Maryland. I spoke recently about the optimal use of IL-12/23 inhibitors. My main focus was on ustekinumab, the currently available IL-12/23 inhibitor for the treatment of inflammatory bowel disease.

Ustekinumab was approved for the treatment of moderate to severe Crohn's disease in 2016 after the UNITI and IM-UNITI trials showed efficacy in induction and maintenance. It was approved in 2019 for the treatment of ulcerative colitis after the UNIFI induction and maintenance trials confirmed efficacy in UC.

Both set of trials also demonstrated significant endoscopic improvement with ustekinumab treatment. Smaller observational studies have shown that ustekinumab may also have a role in treating perianal Crohn's disease and in the prevention of post-operative recurrence of Crohn's disease.

From safety data, from long-term extension trials, and the network meta-analysis, we see that ustekinumab is a very safe agent with no significant difference in rates of adverse effects including infection and malignancy. A couple of studies have suggested a role for therapeutic drug monitoring with higher levels being associated with better clinical and endoscopic outcomes.

However, combination therapy with an immunomodulator doesn't appear to have any superiority in terms of efficacy compared to treatment with ustekinumab alone. It's an exciting time for this class of agents as there are 4 agents currently under investigation that are selective IL-23 inhibitors so with no activity in the IL-12 access.

There are 4 agents in investigation that could have potential advantages in terms of safety and efficacy. These are some of the main points that I discussed at AIBD Regionals. The safety and efficacy of this agent makes it a great tool in the treatment of inflammatory and bowel disease patients.

In particular, the safety on par for vedolizumab makes it valuable as a treatment in, for example, elderly population who may have a higher risk of adverse effects. In addition, it's a convenient agent with sub-q administration.

Overall, it's a great tool for all of us to use in the treatment of IBD and thank you for this opportunity to speak to you.