Mayo Clinic, Jacksonville, Florida, USA.
Ther Clin Risk Manag. 2009;5:935-42. doi: 10.2147/tcrm.s5550.
Treatment options for Crohn's disease have evolved beyond the early goals of induction and remission and are now more focused on preventing complications by altering the natural history of the disease. The advent of biologic therapies has revolutionized the management of Crohn's disease. Specifically, antibodies to tumor necrosis factor alpha induce rapid mucosal healing. This translates into improved patient outcomes. However, many patients will fail these and other therapies. Natalizumab is a new biologic agent that has been approved for the treatment of moderately to severely active Crohn's disease in patients who have failed or are intolerant to immunosuppressants and/or tumor necrosis factor inhibitors. It is a selective adhesion molecule inhibitor to alpha-4 integrin resulting in inhibition of the migration of inflammatory cells across the endothelium. This unique mechanism of action has been shown to be effective in the treatment of Crohn's disease, making it an important option for otherwise refractory patients. Its use has been limited to these refractory patients because of concerns about the development of complications, especially progressive multifocal leukoencephalopathy. In this review, evidence-based data on the indications, efficacy and safety of natalizumab will be presented and its role in the management of patients with Crohn's disease will be defined.
治疗克罗恩病的方法已经超越了早期诱导和缓解的目标，现在更加注重通过改变疾病的自然史来预防并发症。生物治疗的出现彻底改变了克罗恩病的治疗方法。具体来说，肿瘤坏死因子-α的抗体可诱导快速的黏膜愈合。这转化为改善患者的预后。然而，许多患者会对这些治疗方法及其他疗法产生耐药。那他珠单抗是一种新型的生物制剂，已被批准用于治疗对免疫抑制剂和/或肿瘤坏死因子抑制剂治疗无效或不耐受的中度至重度活动期克罗恩病患者。它是一种选择性的α-4 整合素黏附分子抑制剂，可抑制炎症细胞穿过血管内皮的迁移。这种独特的作用机制已被证明对克罗恩病的治疗有效，使其成为对其他难治性患者的重要选择。由于对并发症的发展，特别是进行性多灶性白质脑病的担忧，其仅被限制用于这些难治性患者。在本次综述中，将提出关于那他珠单抗的适应证、疗效和安全性的循证数据，并确定其在克罗恩病患者管理中的作用。
