生物制剂在炎症性肠病中的应用:联合和序贯治疗

Putra Nur Hidayat, M. Simadibrata
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引用次数: 0

摘要

溃疡性结肠炎(UC)和克罗恩病(CD)形式的炎症性肠病(IBD)具有多因素病因和多种炎症途径。使用生物制剂的新疗法被用作常规疗法的辅助疗法。生物制剂如抗肿瘤坏死因子、抗整合素和抗白细胞介素被认为能够克服IBD发生的炎症。IBD治疗的“升级”方法是使用效能低但副作用少的常规药物作为一线,然后使用生物制剂作为二线治疗。然而,结果往往是延误了IBD严重并发症的处理。目前正采用一种“自上而下”的方法,通过早期使用生物制剂来成功预防IBD的严重并发症。生物制剂治疗可在中度至重度IBD中联合或依次启动。但最终,在开始使用生物制剂之前,必须考虑各种参数,如药物有效性、安全性、药物可得性、价格和患者偏好。
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Use of Biologics in Inflammatory Bowel Disease: Combination and Sequential Therapy
Inflammatory bowel disease (IBD) in the form of ulcerative colitis (UC) and Crohn's disease (CD) has multifactorial etiology and multiple inflammatory pathways. Newer treatments with biologic agents are used as an adjunct to conventional therapy. Biological agents such as anti-TNF, anti-integrin, and anti-interleukin are believed to be able to overcome the inflammation that underlies the occurrence of IBD. The “step up” approach in IBD therapy uses conventional drugs with low potency but fewer side effects as the first line, followed by biologic agents as second line therapy. However, the result is often a delay in the management of severe complications of IBD. A “top down” approach is currently being used to successfully prevent severe complications of IBD by using biologic agents early. Biological agent therapy can be initiated in moderate to severe IBD either in combination or sequentially. But in the end, various parameters must be considered before starting the use of biologic agents such as drug effectiveness, safety profile, drug availability, price, and patient preferences.
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