D'Haens G R
Imelda GI Clinical Research Centre, Bonheiden, BELGIUM.
Acta Clin Belg. 2009 Nov-Dec;64(6):540-6. doi: 10.1179/acb.2009.092.
Several trials have shown that early treatment of Crohn's disease with immunomodulators and anti-TNF agents leads to superior clinical outcome including healing of the mucosa. Evidence is mounting that this endpoint is associated with a reduced risk of complications and a reduced need for surgeries and hospitalizations. In the SONIC trial, treatment with the combination of azathioprine and infliximab was the most potent anti-inflammatory therapy in Crohn's disease patients with evidence of active inflammation who had never been exposed to immunomodulators or biologics. These findings have introduced a trend towards earlier initiation of immunomodulator therapy, comparable to what is being done in rheumatoid arthritis. Given the fact that subsets of patients have a favorable disease course without immunomodulator therapy and given the significant potential toxicity of these medications, however, it is becoming a challenge to the gastroenterologists to try and identify patients with an unfavorable disease prognosis and treat these early and aggressively. The key to successful management of Crohn's disease appears to lie in careful timing and selection of the appropriate interventions.
多项试验表明，用免疫调节剂和抗TNF药物对克罗恩病进行早期治疗可带来更好的临床结果，包括黏膜愈合。越来越多的证据表明，这一终点与并发症风险降低以及手术和住院需求减少有关。在SONIC试验中，硫唑嘌呤和英夫利昔单抗联合治疗是克罗恩病患者中最有效的抗炎疗法，这些患者有活动性炎症证据且从未接触过免疫调节剂或生物制剂。这些发现引发了一种趋势，即与类风湿关节炎的治疗方式类似，更早开始免疫调节剂治疗。然而，鉴于部分患者在不进行免疫调节剂治疗的情况下疾病进程良好，且这些药物存在显著的潜在毒性，因此，对胃肠病学家而言，试图识别疾病预后不良的患者并尽早积极治疗成为一项挑战。成功管理克罗恩病的关键似乎在于仔细把握时机并选择合适的干预措施。
