Crohn's disease Three phenotypes, or categories of disease, are present in Crohn's disease: stricturing disease (which causes narrowing of the bowel), penetrating disease (which causes fistulae or abnormal connections of the bowel), and inflammatory disease (which primarily causes inflammation). Fistulizing disease<unk>  was first used for closure of fistulae in Crohn's disease in 1999. In a 94-patient, phase II clinical trial, the researchers showed<unk>  was effective in closing fistulae between the skin and bowel in 56-68% of patients. A large, 296-patient Phase III clinical trial called the ACCENT 2 trial showed<unk>  was additionally beneficial in maintaining closure of fistulae, with almost two-thirds of all patients treated with the three initial doses of<unk>  having a fistula response after 14 weeks, and 36% of patients maintaining closure of fistulae after a year, compared with 19% who received placebo therapy. This final trial resulted in the FDA approval of the drug to treat fistulizing disease. Inflammatory disease<unk>  has been used to induce and maintain remission in inflammatory Crohn's disease. The ACCENT 1 trial, a large, multicentre trial, found 39 to 45% of patients treated with<unk> , who had an initial response to it, maintained remission after 30 weeks, compared with 21% who received placebo treatment. It also showed a mean maintenance of remission from 38 to 54 weeks compared with 21 weeks for patients who received placebo treatment. Crohn's patients have flares of their disease between periods of disease quiescence. Severe flares are usually treated with steroid medications to obtain remission, but steroids have many undesirable side effects, so some gastroenterologists are now advocating the use of<unk>  as the first drug to try to get patients into remission. This has been called the top-down approach to treatment. Ulcerative colitis<unk>  targets TNF, thought to be more related to Th1 cytokines. Ulcerative colitis was thought to be a Th2 disease, and<unk>  would be of limited use. However, patients with ulcerative colitis have begun to be treated with<unk>  on the basis of two large clinical trials conducted in 2005 by Paul Rutgeerts and William Sandborn. The Acute ulcerative Colitis Treatment trials (ACT1 and ACT2) to evaluate the utility of<unk>  in ulcerative colitis showed 44-45% of patients treated with<unk>  for a year maintained a response to the medication, compared with 21% of patients who were treated with placebo medication. At two months, the response was 61-69% for patients treated with<unk> , and 31% for those treated with placebo. Newer drugs such as Etrolizumab have similar efficacy to<unk>  with fewer adverse effects for treatment of ulcerative colitis. Psoriatic arthritis In psoriatic arthritis (PsA), inhibitors of TNF, such as<unk> , improve the signs and symptoms. Several therapies with modest efficacy have been studied in nail psoriasis. Among available agents, higher quality data are available to support the efficacy of cyclosporine and<unk> . Based on studies in AS, the results suggest<unk> , etanercept, and adalimumab have the potential to reduce the signs and symptoms of moderate to severely active axial involvement in PsA in patients who have had an inadequate response to NSAID (level 1a, grade A). The anti-TNF agents<unk>  and etanercept; level 1b, grade A) are more effective for the treatment of enthesitis than traditional agents. Results suggest<unk>  is effective for the treatment of dactylitis in PsA. Other It was approved for treating ankylosing spondylitis, psoriatic arthritis, psoriasis, rheumatoid arthritis.<unk>  is also prescribed (out of indication) for the treatment of Behçet's disease.<unk>  is the most frequently used biological agent in treating relapsing polychondritis. Half of the patients saw benefit from this treatment, and a few other patients experienced infections that in some cases lead to death. There have been numerous case reports of the efficacy of<unk>  in various inflammatory skin conditions diseases; the FDA approved<unk>  for chronic severe plaque psoriasis in adults in September 2006.<unk>  has been used off-label in treating refractory sarcoidosis, where other treatments have not been effective.<unk>  has been tested in chronic obstructive pulmonary disease (COPD) but there was no evidence of benefit with the possibility of harm.<unk>  is indicated for steroid refractory checkpoint inhibitor induced colitis, at a dose of 5 to 10 mg/kg.
Infliximab
Anakinra
Canakinumab
Belatacept
Vedolizumab
Avelumab
Mepolizumab
Sarilumab