Targeting Objective Treatment Goals in Crohn's Disease - Episode 9

Role of IL-12/23 Inhibitors and IL-23 Inhibitors in CD

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David Rubin, MD, reviews the use of IL-12 and IL-23 inhibitors in the treatment of CD, highlighting ustekinumab and risankizumab for first-line therapy and beyond.

This is a video synopsis/summary of a panel discussion involving Marla Dubinsky, MD; David Rubin, MD; Miguel Regueiro, MD; Remo Panaccione, MD, FRCPC; and Sara Horst, MD, MPH.

In this discussion, the focus is on IL (interleukin)-23 inhibitors. The conversation explores the effectiveness and confidence surrounding IL-23 inhibitors, particularly anti-P40 antibodies and emerging P19 antibodies. The speaker highlights the dual impact of anti-P40 antibodies on both IL-12 and IL-23, while P19 antibodies specifically target IL-23.

The speaker notes the safety and efficacy of both types of IL-23 inhibitors in treating moderate to severe Crohn's disease. The discussion delves into the unique immunological aspects of IL-23, emphasizing its tissue-specific expression rather than a broad impact on the immune system. The effectiveness of IL-23 inhibitors in addressing skin inflammation is acknowledged, making them a favorable choice for patients with both skin conditions and Crohn's disease.

The conversation incorporates recent head-to-head data comparing P19 and P40 inhibitors in patients previously on anti-TNF (tumor necrosis factor) therapy. The results indicate that P19 inhibitors were approximately 20% more effective across various endpoints, providing valuable insights into the specificity and dosing of IL-23 inhibitors.

The speaker expresses comfort in using IL-23 inhibitors as a first-line therapy for Crohn's disease and considers them a viable second-line option. Furthermore, the potential benefits of IL-23 inhibitors in post-operative Crohn's patients and those with less complex perianal disease are highlighted. The speaker also emphasizes the significance of IL-23 inhibitors as an option during pregnancy, distinguishing them from small molecules.

In summary, the discussion positions IL-23 inhibitors, particularly P19 antibodies, as a significant addition to the treatment arsenal for Crohn's disease. The emerging head-to-head data contributes to a more informed approach to therapy selection, and the speaker underscores the ease of discussing this option with patients. Overall, IL-23 inhibitors are portrayed as a versatile and valuable choice in the evolving landscape of Crohn's disease management.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.