Gastroenterology Department, Hospital Clinic i Provincial, CIBER-EHD, Barcelona, Spain.
Drugs. 2010;70(2):109-20. doi: 10.2165/11533700-000000000-00000.
Crohn's disease is a chronic, disabling, inflammatory condition of the gastrointestinal tract that has a segmental distribution and can affect the entire gastrointestinal tract. Treatment of patients with Crohn's disease represents a difficult challenge to physicians. Conventional therapy includes corticosteroids and immunosuppressants. Corticosteroids are highly effective for inducing response and remission, but the results in the long-term are disappointing and are associated with serious adverse events. Immunosuppressants are effective, but have a slow onset of action and are associated with intolerance and adverse events. In the last decade, as a result of a better understanding of the immunopathology of inflammatory bowel disease, novel therapeutic agents have been developed to target crucial components of the inflammatory cascade. Tumour necrosis factor (TNF) inhibitors (infliximab, adalimumab and certolizumab pegol) offer an effective alternative therapy, and are widely used in clinical practice for the management of Crohn's disease and ulcerative colitis. This article focuses on the latest evidence-based data on clinical effectiveness, mucosal healing, immunogenicity, dose optimization for induction and maintenance of response and remission, and step-up versus top-down approaches of the available TNF inhibitors for the treatment of Crohn's disease.
克罗恩病是一种慢性、致残性、胃肠道炎症性疾病，呈节段性分布，可累及整个胃肠道。治疗克罗恩病患者对医生来说是一个巨大的挑战。传统的治疗方法包括皮质类固醇和免疫抑制剂。皮质类固醇对诱导缓解和缓解非常有效，但长期效果令人失望，且与严重的不良反应有关。免疫抑制剂有效，但起效缓慢，且与不耐受和不良反应有关。在过去十年中，由于对炎症性肠病的免疫病理学有了更好的了解，新型治疗药物已被开发出来，以针对炎症级联反应的关键成分。肿瘤坏死因子（TNF）抑制剂（英夫利昔单抗、阿达木单抗和培塞利珠单抗）提供了一种有效的替代治疗方法，在临床实践中广泛用于治疗克罗恩病和溃疡性结肠炎。本文重点介绍了关于这些 TNF 抑制剂在治疗克罗恩病方面的临床疗效、黏膜愈合、免疫原性、诱导和维持缓解和缓解的剂量优化、以及升阶梯与降阶梯方法的最新循证数据。
