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Enfermedad de Crohn: más allá de los antagonistas del factor de necrosis tumoral

Laurent Peyrin-Biroulet¹, Pierre Desreumaux, William J Sandborn

¹Hôpital Claude Huriez, Centre Hospitalier Universitaire de Lille, Lille, France.

Lancet (London, England)

|July 8, 2008

Resumen

Se necesitan nuevos agentes terapéuticos para la enfermedad de Crohn debido a las respuestas variables a los antagonistas del factor de necrosis tumoral. La investigación se está desplazando hacia el refuerzo de la barrera intestinal y apuntando a la inmunidad innata junto con el sistema inmune adquirido.

Área de la Ciencia:

Gastroenterología e Inmunología.
Desarrollo de Drogas Desarrollo de Drogas.
Enfermedades Inflamatorias del Intestino Investigación de la Enfermedad del Intestino.

Sus antecedentes:

Los antagonistas del factor de necrosis tumoral (TNF) han demostrado beneficios terapéuticos en la enfermedad de Crohn, pero la variabilidad de la respuesta requiere nuevas estrategias de tratamiento.
La comprensión de la fisiopatología de la enfermedad de Crohn ha avanzado, destacando las funciones del sistema inmunológico adquirido (linfocitos, citocinas, moléculas de adhesión).
La evidencia emergente implica el sistema inmunológico innato y el epitelio intestinal, lo que provoca un cambio hacia el refuerzo de la barrera.

Objetivo del estudio:

Revisar los mecanismos de acción de los nuevos agentes terapéuticos para la enfermedad de Crohn.
Evaluar la eficacia y los eventos adversos de nuevos medicamentos basados en datos de ensayos clínicos.
Discutir las direcciones terapéuticas futuras y los puntos finales óptimos para el desarrollo de fármacos.

Principales métodos:

Revisión de la literatura existente y los datos de ensayos clínicos sobre nuevas terapias de la enfermedad de Crohn.
Análisis de los mecanismos farmacológicos dirigidos tanto a las vías inmunes adquiridas como a las innatas.
Evaluación de los perfiles de eficacia y seguridad de los agentes en investigación.

Principales resultados:

Se están desarrollando nuevos agentes terapéuticos con diversos mecanismos de acción.
Los ensayos clínicos proporcionan datos sobre la eficacia y los eventos adversos de estos nuevos medicamentos.
El panorama terapéutico está evolucionando más allá de la inmunosupresión para incluir la mejora de la barrera.

Conclusiones:

Están surgiendo nuevas estrategias terapéuticas para la enfermedad de Crohn, que abordan las limitaciones de los tratamientos actuales.
Es evidente un cambio de paradigma hacia el refuerzo de la barrera intestinal y la modulación de la inmunidad innata.
La investigación futura debe centrarse en el desarrollo de nuevos fármacos con puntos finales optimizados para mejorar los resultados de los pacientes.

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