Imelda GI Clinical Research Center, Imeldalaan 9, 2820 Bonheiden, Belgium.
Nat Rev Gastroenterol Hepatol. 2010 Feb;7(2):86-92. doi: 10.1038/nrgastro.2009.222.
Several trials have shown that early treatment of Crohn's disease with immunomodulators and anti-TNF agents leads to a superior clinical outcome, including healing of the mucosa, compared with standard therapy alone. Mounting evidence indicates that mucosal healing is associated with a reduced risk of complications, and a reduced need for surgeries and hospitalizations. In the SONIC trial, a combination of the standard azathioprine immunomodulator therapy and infliximab, an anti-TNF agent, had more potent anti-inflammatory effects than either drug alone in patients with Crohn's disease who had evidence of active inflammation. These findings and those from rheumatoid arthritis trials have prompted the investigation of early initiation of immunomodulator (standard or anti-TNF) therapy for Crohn's disease, in suitable patients, which has led to substantial improvements in disease management. Careful selection of patients is, however, essential given the potential risk of toxic effects from these therapies and the fact that some patients with IBD will have a favorable disease course without them. Identification of suitable patients, however, remains a challenge, as genetic, phenotypic and environmental factors have not yet been identified that can be used for routine assessment and selection is mainly based on clinical criteria.
几项试验表明，与单独标准治疗相比，早期使用免疫调节剂和抗 TNF 药物治疗克罗恩病可获得更好的临床结局，包括黏膜愈合。越来越多的证据表明，黏膜愈合与并发症风险降低以及手术和住院需求减少相关。在 SONIC 试验中，与单独使用任一药物相比，在有活性炎症证据的克罗恩病患者中，标准免疫调节剂（硫唑嘌呤）联合抗 TNF 药物英夫利昔单抗具有更强的抗炎作用。这些发现以及类风湿关节炎试验的结果促使人们研究在适当的患者中早期开始免疫调节剂（标准或抗 TNF）治疗克罗恩病，这导致疾病管理得到了实质性改善。然而，鉴于这些治疗方法存在潜在的毒性作用，并且一些 IBD 患者无需这些治疗也可获得良好的病程，因此仔细选择患者至关重要。然而，适合的患者的识别仍然是一个挑战，因为尚未确定可用于常规评估的遗传、表型和环境因素，选择主要基于临床标准。
