在炎症性肠病治疗中优先考虑.
Klaus R Herrlinger1, Eduard F Stange2
1Internal Medicine I, Asklepios Klinik, Hamburg, Germany.
Expert review of gastroenterology & hepatology
|July 22, 2023
概括
本综述提供了针对复杂炎症性肠病 (IBD) 病例,包括克罗恩病和性结肠炎的最佳疗法选择的指导. 它优先考虑特定的生物药物和JAK抑制剂,以应对具有挑战性的治疗方案.
科学领域:
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 目前的炎症性肠病 (IBD) 准则通常建议使用常规疗法,如氨基酸盐或类固醇,逐步进行治疗.
- 这些指导方针可能不能充分优先考虑先进的治疗方法,如生物药物和简氏激酶 (JAK) 抑制剂,用于复杂的IBD病例.
研究的目的:
- 为优化和个性化治疗克罗恩病 (CD) 和性结肠炎 (UC) 决策提供基于证据的帮助,特别是在难以治疗的患者中.
- 分析当前的文献,以指导复杂IBD管理的先进疗法选择.
主要方法:
- 使用PubMed进行了连续的文献审查.
- 关键搜索词包括"克罗恩病"和"性结肠炎",以确定相关出版物.
主要成果:
- 对于类固醇耐药的克罗恩病,建议初始治疗是联合因弗利克西马布加上阿扎西奥普林或瑞桑基祖马布,如果初始治疗失败,则接下来是乌斯特基努马布或阿达利努马布.
- 对于类固醇耐药性性结肠炎,一线治疗应包括infliximab加上azathioprine或upadacitinib,而filgotinib,tofacitinib或ustekinumab作为二线选择.
- 对于CD和UC的类固醇依赖疗程,建议使用azathioprine或vedolizumab作为一线治疗,并使用infliximab或JAK抑制剂作为二线治疗.
结论:
- 数据表明,用于管理类固醇耐药性和类固醇依赖性IBD的特定治疗序列.
- 这些基于证据的结论可以帮助临床医生为患有复杂IBD的患者做出个性化治疗决定.
- 个性化治疗选择对于改善具有挑战性的IBD病例的结果至关重要.
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