Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Case Reports Volume 6 Issue 11

Comprehensive Review and Meta-Analysis of Management Regimens for Inflammatory Bowel Disease Including the Costs and Future Direction

Rajeev Gupta*

Consultant Paediatrician, Chairman Central Specialist Committee Royal College of Paediatrics and Child Health, Barnsley Foundation Hospital, United Kingdom

*Corresponding Author: Rajeev Gupta, Consultant Paediatrician, Chairman Central Specialist Committee Royal College of Paediatrics and Child Health, Barnsley Foundation Hospital, United Kingdom.

Received: July 24, 2023; Published: October 06, 2023


Inflammatory Bowel Disease (IBD), encompassing Crohn's disease and ulcerative colitis, represents a group of chronic and often debilitating conditions. The therapeutic landscape of IBD has transformed over the past decades, evolving from the use of corticosteroids and immunomodulators to targeted biologics and small molecule inhibitors. However, choosing the appropriate treatment remains a challenging clinical decision, given the variability in patient responses, the potential for side effects, high costs, and varying administration routes. This comprehensive review and meta-analysis aims to review and analyse recent studies on the efficacy, safety, and cost-effectiveness of different IBD treatment regimens. The results indicate that while newer therapies have significantly improved disease outcomes and quality of life, issues such as side effects, loss of response over time, high costs, and administration challenges persist. These findings highlight the need for further research to refine current treatment strategies, enhance our understanding of disease pathogenesis, and move towards personalized medicine in IBD management. Importantly, the rising global prevalence and associated costs of IBD underscore the urgency for more accessible and effective treatments. In conclusion, the journey towards the ideal IBD treatment, which is safe, efficacious, cost-effective, and tailored to individual patient needs, is ongoing, and continued research is vital in bringing us closer to this goal.

Keywords: Meta-Analysis; Regimens; Inflammatory Bowel Disease; Costs; Future Direction


  1. Ng SC., et al. “Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies”. Lancet10114 (2017): 2769-2778.
  2. de Souza HSP and Fiocchi C. “Immunopathogenesis of IBD: current state of the art. Nat. Rev. Gastroenterol”. Hepatology1 (2016): 13-27.
  3. Rubin DT., et al. “ACG Clinical Guideline: Ulcerative Colitis in Adults”. American Journal of Gastroenterology3 (2019): 384-413.
  4. Ben-Horin S and Chowers Y. “Review article: loss of response to anti-TNF treatments in Crohn's disease”. Alimentary Pharmacology and Therapeutics 9 (2008): 744-753.
  5. Sandborn WJ and Hanauer SB. “Antitumor necrosis factor therapy for inflammatory bowel disease: a review of agents, pharmacology, clinical results, and safety”. Inflammatory Bowel Disease2 (1999): 119-133.
  6. Colombel JF., et al. “Infliximab, azathioprine, or combination therapy for Crohn's disease”. The New England Journal of Medicine15 (2010): 1383-1395.
  7. Feagan BG., et al. “Vedolizumab as induction and maintenance therapy for ulcerative colitis”. The New England Journal of Medicine8 (2013): 699-710.
  8. Sandborn WJ., et al. “Vedolizumab as induction and maintenance therapy for Crohn's disease”. The New England Journal of Medicine8 (2013): 711-721.
  9. Baumgart DC and Sandborn WJ. “Inflammatory bowel disease: clinical aspects and established and evolving therapies”. Lancet9573 (2007): 1641-1657.
  10. Sandborn WJ., et al. “Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis”. The New England Journal of Medicine18 (2017): 1723-1736.
  11. Kim JW and Kim SY. “The Era of Janus Kinase Inhibitors for Inflammatory Bowel Disease Treatment”. International Journal of Molecular Sciences21 (2021): 11322.
  12. Ford AC., et al. “Efficacy of 5-aminosalicylates in ulcerative colitis: systematic review and meta-analysis”. American Journal of Gastroenterology4 (2011): 601-616.
  13. Bernstein CN., et al. “World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010”. Inflammatory Bowel Disease1 (2010): 112-124.
  14. Timmer A., et al. “Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis”. Cochrane Database of Systematic Reviews 1 (2007):
  15. Prefontaine E., et al. “Azathioprine or 6-mercaptopurine for maintenance of remission in Crohn's disease”. Cochrane Database of Systematic Reviews 1 (2009):
  16. Siegel CA. “Shared decision making in inflammatory bowel disease: helping patients understand the tradeoffs between treatment options”. Gut3 (2012): 459-465.
  17. Chaparro M., et al. “Safety of thiopurine therapy in inflammatory bowel disease: long-term follow-up study of 3931 patients”. Inflammatory Bowel Disease7 (2013): 1404-1410.
  18. Hanauer SB., et al. “Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn's disease: the CLASSIC-I trial”. Gastroenterology 2 (2006): 323-333.
  19. Colombel JF., et al. “Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: the CHARM trial”. Gastroenterology 1 (2007): 52-65.
  20. Sandborn WJ., et al. “Certolizumab pegol in patients with moderate to severe Crohn's disease and secondary failure to infliximab”. Clinical Gastroenterology and Hepatology 8 (2010): 688-695.e2.
  21. Lichtenstein GR., et al. “Serious infection and mortality in patients with Crohn's disease: more than 5 years of follow-up in the TREAT™ registry”. American Journal of Gastroenterology9 (2012): 1409-1422.
  22. Hyun HK., et al. “Comparative effectiveness of second-line biological therapies for ulcerative colitis and Crohn's disease in patients with prior failure of anti-tumour necrosis factor treatment”. BMC Gastroenterology1 (2022): 143.
  23. S. Food and Drug Administration. “FDA warns about increased risk of blood clots and of death with higher dose of tofacitinib (Xeljanz, Xeljanz XR) in rheumatoid arthritis patients; FDA to investigate. Safety Announcement.
  24. Katsanos KH and Papadakis KA. “Inflammatory bowel disease: updates on molecular targets for biologics”. Gut Liver5 (2010): 574-584.
  25. Beaugerie L., et al. “Predicting, Preventing, and Managing Treatment-Related Complications in Patients with Inflammatory Bowel Diseases”. Clinical Gastroenterology and Hepatology 6 (2020): 1324-1335.e2.
  26. Zhang Y., et al. “Discovery of bioactive microbial gene products in inflammatory bowel disease”. Nature 7915 (2022): 754-760.
  27. Kaplan GG and Ng SC. “Understanding and Preventing the Global Increase of Inflammatory Bowel Disease”. Gastroenterology 2 (2017): 313-321.e2
  28. Park KT., et al. “The Cost of Inflammatory Bowel Disease: An Initiative from the Crohn’s and Colitis Foundation”. Inflammatory Bowel Diseases1 (2020): 1-10.
  29. Trigo-Vicente C., et al. “Cost-effectiveness analysis of infliximab, adalimumab, golimumab, vedolizumab and tofacitinib for moderate to severe ulcerative colitis in Spain”. European Journal of Hospital Pharmacy 6 (2020): 355-360.
  30. Blackhouse G., et al. “Canadian cost-utility analysis of initiation and maintenance treatment with anti-TNF-α drugs for refractory Crohn's disease”. Journal of Crohn's and Colitis 1 (2012): 77-85.
  31. Danese S., et al. “Biosimilars in IBD: from theory to practice”. Nature Reviews Gastroenterology and Hepatology 1 (2017): 22-31.
  32. Jørgensen KK., et al. “NOR-SWITCH study group. Switching from originator infliximab to biosimilar CT-P13 compared with maintained treatment with originator infliximab (NOR-SWITCH): a 52-week, randomised, double-blind, non-inferiority trial”. Lancet 10086 (2017): 2304-2316.
  33. Jackson CA., et al. “Factors associated with non-adherence to oral medication for inflammatory bowel disease: a systematic review”. American Journal of Gastroenterology3 (2010): 525-539.
  34. Selinger CP., et al. “Modifiable factors associated with nonadherence to maintenance medication for inflammatory bowel disease”. Inflammatory Bowel Disease10 (2010): 2199-2206.
  35. Kaplan GG. “The global burden of IBD: from 2015 to 2025”. Nature Reviews Gastroenterology and Hepatology 12 (2015): 720-727.
  36. Zittan E., et al. “The New Proactive Approach and Precision Medicine in Crohn's Disease”. Biomedicines7 (2020): 193.
  37. Li DF., et al. “Extracellular Vesicles: The Next Generation Theranostic Nanomedicine for Inflammatory Bowel Disease”. International Journal of Nanomedicine 17 (2022): 3893-3911.
  38. Schirmer M., et al. “Dynamics of metatranscription in the inflammatory bowel disease gut microbiome”. Nature Microbiology 3 (2018): 337-346.
  39. Sartor RB and Wu GD. “Roles for Intestinal Bacteria, Viruses, and Fungi in Pathogenesis of Inflammatory Bowel Diseases and Therapeutic Approaches”. Gastroenterology2 (2017): 327-339.
  40. Sood A., et al. “Fecal Microbiota Transplantation for Ulcerative Colitis: An Evolving Therapy”. Crohns Colitis 360 4 (2020): otaa067.
  41. Ohkusa T., et al. “Gastrointestinal disorders and intestinal bacteria: Advances in research and applications in therapy”. Frontiers in Medicine (Lausanne) 9 (2023): 935676.
  42. Citation

    Citation: Rajeev Gupta. “Comprehensive Review and Meta-Analysis of Management Regimens for Inflammatory Bowel Disease Including the Costs and Future Direction".Acta Scientific Gastrointestinal Disorders 6.11 (2023): 11-18.


    Copyright: © 2023 Rajeev Gupta. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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