在炎症性肠病中停止治疗:当前观点
Antonio Meštrović1, Marko Kumric2, Josko Bozic3
1Department of Gastroenterology, University Hospital of Split, Split 21000, Croatia.
停止炎症性肠病 (IBD) 治疗可能会使超过50%的患者复发. 便中的calprotectin水平和其他因素有助于在停止药物治疗之前预测复发风险.
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:
- 炎症性肠病 (IBD) 的有效管理依赖于及时的药物引入和以目标为导向的治疗.
- 维持缓解是一个关键的挑战,导致考虑治疗减缓或中止由于副作用和成本.
- 所有IBD药物在停用后都有复发的风险,超过50%的患者出现疾病复发.
研究的目的:
- 审查当前对药物戒断在IBD管理中的理解.
- 为了确定治疗停止后疾病复发的预测因素.
- 为了告知临床决策有关IBD药物停用.
主要方法:
- 对IBD治疗中断的研究和元分析的文献综述.
- 对复发的预测因素的分析.
- 讨论影响停药决定的因素.
主要成果:
- 在停止IBD治疗后,复发率超过50%,特别是在单疗法 (氨基酸盐,免疫调节剂,生物药物) 后.
- 联合疗法 (免疫调节剂和抗TNF) 戒断显示出更长的无复发期.
- 便中的calprotectin水平是复发的最强预测因素;其他因素包括疾病活动指数,年龄,疾病持续时间,吸烟和先前的类固醇使用.
结论:
- 停止IBD治疗需要仔细选择患者,并考虑预测因素,以最大限度地降低复发风险.
- 便中的calprotectin是评估复发风险的关键生物标志物.
- 个性化治疗决策,平衡疾病严重程度,复发风险和患者偏好,至关重要.
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