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Breaking through the therapeutic ceiling of inflammatory bowel disease: Dual-targeted therapies - 13/01/23

Doi : 10.1016/j.biopha.2022.114174 
Zelin Feng a, 1, Guangbo Kang b, c, d, 1, Jiewen Wang b, c, d, Xingjie Gao e, Xiaoli Wang a, Yulin Ye a, Limin Liu a, Jingwen Zhao a, Xinjuan Liu f, He Huang b, c, , Xiaocang Cao a,
a Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin Institute of Digestive Disease, Tianjin Key Laboratory of Digestive Diseases, Tianjin 300052, China 
b Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China 
c Frontiers Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300072, China 
d Institute of Shaoxing, Tianjin University, Zhejiang 312300, China 
e Department of Biochemistry and Molecular Biology, School of Basic Medical Science, Tianjin Medical University, Tianjin 300070, China 
f Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100016, China 

Correspondence to: Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China.Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin UniversityTianjin300350China⁎⁎Corresponding author.

Abstract

Emerging biologics and small-molecule drugs have changed the clinical status quo of inflammatory bowel disease (IBD). However, current treatments remain at a standstill in terms of response and remission in many cases. Accumulating evidence indicates that dual-targeted therapy (DTT) could be promising in overcoming the existing ceiling of IBD treatment. However, data on the efficacy and safety of DTT on Crohn’s disease and ulcerative colitis are still limited or insufficient. Moreover, there is a lack of studies delineating the mechanisms of DTT. Given that various targeted drugs have different targets among the extensive redundant inflammatory networks, DTT could result in various outcomes. In this review, we have summarized the current data on the safety, effectiveness, and clinical development status of novel targeted drugs related to refractory IBD, and have explored the mechanism of action of therapy. We have categorized therapeutic agents into “Therapeutic Agents Targeting Cellular Signaling Pathways” and “Therapeutic Agents Targeting Leukocyte Trafficking” based on the different therapeutic targets, and also by classifying therapeutic agents targeting the cellular signaling pathways into “JAK-dependent” and “JAK-independent,” and placed the existing drug combinations into 3 categories based on their mechanisms, namely, overlapping, synergistic, and complementary effects. Lastly, we have proposed the possible mechanisms of DTT to conceive a theoretical framework for clinical decision-making and further drug development and research from an IBD standpoint.

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Graphical Abstract




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Highlights

Emerging biologics and small molecule drugs are navigating the clinical landscape of inflammatory bowel disease (IBD).
Dual-targeted therapy (DTT) is expected to overcome the ceiling of existing IBD therapies.
The existing drug combinations were classified into three categories: overlapping, synergistic and complementary effect.
From the perspective of the clinician, the most appropriate drug combination is selected for patients according to the MOA.

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Keywords : Inflammatory bowel diseases, Dual-targeted therapy, Janus kinases pathway, Tumor necrosis factor-alpha, Leukocyte trafficking

Abbreviations : IBD, DTT, JAKpathway, TNF-α


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Vol 158

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