Alicaforsen

Vegter S, et al. Alimentary Pharmacology & Therapeutics, 2013, 38(3), 284-293.

Alicaforseninhibits intercellular adhesion molecule-1 (ICAM-1), and has emerged as a promising therapy for active ulcerative colitis (UC), particularly in patients with moderate-to-severe distal disease. This agent is delivered via enema, targeting the localized inflammation characteristic of UC while minimizing systemic exposure.
Meta-analysis of individual patient data from four phase 2 trials demonstrated Alicaforsen's efficacy in inducing and maintaining remission. Short-term outcomes (weeks 6-10) revealed significant improvements in patients with disease extent up to 40 cm from the anal verge, particularly those with moderate or severe UC. While high-dose mesalazine enemas also showed initial efficacy, Alicaforsen demonstrated superior durability at week 30, maintaining efficacy when mesalazine's benefits waned.
Alicaforsen's mechanism involves reducing ICAM-1 expression, a critical mediator of leukocyte adhesion and migration in the inflammatory cascade. By mitigating local inflammation, Alicaforsen addresses both symptoms and potential disease progression. Its durable response in distal UC suggests a disease-modifying capability, setting it apart from standard anti-inflammatory treatments.