New immunologic treatments for inflammatory bowel disease

After many years with little progress in new treatments for patients with i nflammatory bowel disease, there is now rapid expansion of a new class of i mmunologic agents. These agents are designed to disrupt proinflammatory pat hways at specific sites, Monoclonal antibodies to tumor necrosis factor-alpha (TNF-alpha) are alread y transforming the lives of some patients with previously intractable Crohn disease, and further TNF-alpha directed therapies are being developed. Cli nical trials are now underway on agents that inhibit adhesion molecules and antiinflammatory cytokines, while attempts are being made to actively immu nize against TNF-alpha. Promising data continue to be reported, although long-term safety data are still mostly unavailable. Although these agents are proving to be very effe ctive in the treatment of patients with Crohn disease, their use should con tinue to be restricted while indications and dose regimens are defined. (C) 2000 Lippincott Williams & Wilkins, Inc.