Addressing the Critical Gap in Biological Therapies for Inflammatory Bowel Disease in Syria

Syria's evolving health care landscape demands urgent attention to the unmet therapeutic needs of patients with inflammatory bowel disease (IBD). The discontinuation of biological therapies—cornerstones of modern IBD management—has deprived patients of treatments proven to induce remission, promote mucosal healing, and reduce complications in Crohn's disease and ulcerative colitis.[1] [2] Systemic governance failures and economic sanctions have severely restricted access to Food and Drug Administration (FDA)-approved biologics, leading to reliance on unapproved biocopies.

This practice raises significant safety concerns and ethical dilemmas, as patients are often unaware of the risks associated with untested alternatives. Historically, Syria's pharmaceutical infrastructure has been eroded by underinvestment, hospital destruction, and workforce attrition, reflecting a broader pattern of systemic neglect.[3] [4]

The clinical implications are profound. Patients now face heightened risks of disease flare-ups, hospitalizations, and surgical interventions. Substandard biocopies, which lack rigorous pharmacokinetic validation, correlate with inconsistent outcomes, increased morbidity, and potential harm. These challenges contravene principles of evidence-based medicine and patient autonomy, as individuals are deprived of informed consent regarding therapeutic risks.[5] [6]

Reinstating access to biologics demands robust multisectoral collaboration. Policymakers must prioritize integrating FDA-approved agents—adalimumab, infliximab, and ustekinumab—into national protocols. This requires comprehensive training programs for health care professionals to optimize IBD management, particularly in severe cases such as steroid-refractory pancolitis. Concurrently, partnerships with international organizations (e.g., the World Health Organization and United Nations High Commissioner for Refugees) could address supply chain barriers and secure funding for sustainable access.[7] [8]

Ultimately, Syria's health care reforms must prioritize equitable access to biologics within a chronic disease strategy. Addressing this gap will mitigate preventable morbidity, reduce long-term costs, and align care with global standards. We urge the international medical community to advocate for policy changes and resource mobilization, ensuring Syrian patients receive therapies that meet universal safety and efficacy benchmarks. Restoring trust in Syria's health care system hinges on sustained advocacy, cross-border collaboration, and an unwavering commitment to patient-centered care.[9]

Conflict of Interest

None declared.

• References

• 1 Hurtado-Lorenzo A, Swantek JL. The landscape of new therapeutic opportunities for IBD. Adv Pharmacol 2024; 101: 1-83
• 2 Revés J, Ungaro RC, Torres J. Unmet needs in inflammatory bowel disease. Curr Res Pharmacol Drug Discov 2021; 2: 100070
• 3 Irfan B, Tarab B, Alabed A. Syria's Bashar al-Assad: the crimes of a physician. Lancet 2025; 405 (10473): 119
• 4 Astier A, Abouqal R, Abid L, Aoudia Y, Ahid S. Biosimilarity. Do not confuse biosimilar and biocopy. Example of tenecteplase. Ann Pharm Fr 2023; 81 (06) 942-949
• 5 Rifkin RM, Peck SR. Biosimilars: implications for clinical practice. J Oncol Pract 2017; 13 (9_suppl, suppl): 24s-31s
• 6 Sweileh WM. Substandard and falsified medical products: bibliometric analysis and mapping of scientific research. Global Health 2021; 17 (01) 114
• 7 Juillerat P, Grueber MM, Ruetsch R, Santi G, Vuillèmoz M, Michetti P. Positioning biologics in the treatment of IBD: a practical guide - Which mechanism of action for whom? . Curr Res Pharmacol Drug Discov 2022; 3: 100104
• 8 Dulai PS, Osterman MT, Lasch K, Cao C, Riaz F, Sandborn WJ. Market access analysis of biologics and small-molecule inhibitors for inflammatory bowel disease among US health insurance policies. Dig Dis Sci 2019; 64 (09) 2478-2488
• 9 Kherallah M, Alahfez T, Sahloul Z, Eddin KD, Jamil G. Health care in Syria before and during the crisis. Avicenna J Med 2012; 2 (03) 51-53

Publication History

Article published online:
21 May 2025