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World J Gastroenterol. Dec 28, 2022; 28(48): 6888-6899
Published online Dec 28, 2022. doi: 10.3748/wjg.v28.i48.6888
Current status of novel biologics and small molecule drugs in the individualized treatment of inflammatory bowel disease
Yi-Han Xu, Wei-Ming Zhu, Zhen Guo
Yi-Han Xu, Wei-Ming Zhu, Zhen Guo, Department of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
Author contributions: Xu YH and Guo Z performed the majority of the writing and the table; Zhu WM designed the outline and coordinated the writing of the paper; and all authors have read and approve the final manuscript.
Supported by Jiangsu Provincial Health Commission, No. M2021013; and the Science Foundation of Jinling Hospital, No. YYMS2021035.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen Guo, MD, PhD, Professor, Department of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China. guozhi0809@sina.com
Received: September 13, 2022
Peer-review started: September 13, 2022
First decision: November 5, 2022
Revised: November 11, 2022
Accepted: December 1, 2022
Article in press: December 1, 2022
Published online: December 28, 2022
Abstract

Treatment strategies for inflammatory bowel disease (IBD) are rapidly evolving with the development of biologics and small molecule drugs (SMDs). However, these drugs are not guaranteed to be effective in all patients, and a “ceiling effect” of biologic monotherapy may occur. This issue highlights an unmet need for optimizing the use of biologics and predicting therapeutic responses. Thus, the development of new drugs with novel mechanisms of action is urgently needed for patients with primary nonresponse and secondary loss of response to conventional biologics and SMDs. In addition, combining different biologics or SMDs has been proposed as a novel strategy to enhance treatment efficacy in IBD, which theoretically has multidimensional anti-inflammatory potential. Based on the current evidence available for IBD, dual targeted therapy may be a promising strategy for refractory IBD patients who have failed in multiple biologic trea-tments or who have extraintestinal manifestation. Additionally, identifying the subgroup of IBD patients who are responding to biological combination therapies is also equally important in stable disease remission. In this review, we sum-marize the newly developed biologics and SMDs and the current status of bio-logics/SMDs to highlight the development of individualized treatment in IBD.

Keywords: Inflammatory bowel diseases, Biologic, Dual targeted therapy, Therapeutic drug monitoring, Bispecific antibodies

Core Tip: The emergence of biologics and small molecules has significantly changed the therapies used for inflammatory bowel disease (IBD). However, the efficacy of these drugs is not satisfactory for every patient, which indicates an unmet need for optimizing the use of biologics/small molecules and for predicting therapeutic responses. Here, we describe the current status of novel biologics and small molecules and new treatment strategies to combat IBD by using more than one biologic.