Unmet Medical Need

IBD affects approximately 1 million people in the USA, with an estimated indirect cost from loss of work alone in excess of $4 billion per year. The therapeutic goal in the management of IBD is to treat the active symptomatic disease of all patients and to restore mucosal integrity and function. The treatment of mild-to-moderate disease is adequately managed with current 5-ASA and topical corticosteroid therapies (Table 3). However, invariably the disease progresses and becomes more difficult to control. Furthermore, a significant proportion of CD and UC patients become refractory to standard treatment and this necessitates the use of powerful immunosuppressant drugs, such as azathioprine, methotrexate, or 6-mercaptopurine, or resective surgery. Patients are highly motivated to seek out alternative therapies with the promise of efficacy and which avoid the inevitability of surgery. The disease management of pediatric IBD remains a significant unmet challenge.

There is an increasing clinical use and reliance on anti-TNF-a agents for the treatment of steroid refractory, or fistulating CD. The effectiveness of these agents in severe CD has revolutionized the treatment of this patient group, despite their cost and notable side effects. For the induction and maintenance of remission infliximab is given as an intravenous infusion. It is a chimeric mouse/human immunoglobulin G1 (IgG1) anti-TNF-a antibody with high levels of immunogenicity, which is both a cause of erythema and reactions during infusion, and reduces the pharmacokinetic half-life, increasing the risk of systemic infections. While other anti-TNF-a approaches are in clinical development (Onercept, CDP-870, ISIS 104838, etc.), none is likely to avoid the core issue relating to increased risks of opportunistic infection and malignancy. Additionally, approximately 30% of CD patients will not respond to infliximab and currently the agent has not been approved for use in patients with UC, although clinical trials are ongoing. Embracing the precedence set by novel biological approaches to disease management, other agents such as Leukine/sargramostim (recombinant human granulocyte macrophage colony stimulating factor (GM-CSF)), daclizumab (humanized anti-IL2 receptor antibody), fontolizumab (humanized anti-interferon gamma (IFN-g) antibody), CNTO 1275 and ABT-874 (anti-IL12 monoclonal antibodies (mAbs)), MLN-02 (humanized anti-a4b7 antibody), and MDX-1100 (fully human anti-IP-10 antibody) have entered clinical trials in order to address the shortfall in safe and effective agents that have the widest utility within the IBD community. The long duration of action of biologics, compared with small-molecule approaches, is both their potential attraction and downfall. None so far is devoid of immunogenicity issues, even the fully human anti-TNF-a monoclonal antibody Humira/ adalimumab. The discovery of novel small-molecule agents, which can fill the void in efficacy, is a rich and active area of research.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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