D'Haens Geert R, Sartor R Balfour, Silverberg Mark S, Petersson Joel, Rutgeerts Paul
Department of Gastroenterology, Academic Medical Centre, University of Amsterdam, The Netherlands.
Division of Gastroenterology and Hepatology, Multidisciplinary IBD Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
J Crohns Colitis. 2014 Aug;8(8):726-34. doi: 10.1016/j.crohns.2014.02.025. Epub 2014 Apr 16.
Clinical management of inflammatory bowel diseases (IBD), new treatment modalities and the potential impact of personalised medicine remain topics of intense interest as our understanding of the pathophysiology of IBD expands.
Potential future strategies for IBD management are discussed, based on recent preclinical and clinical research.
A top-down approach to medical therapy is increasingly being adopted for patients with risk factors for severe inflammation or an unfavourable disease course in an attempt to halt the inflammatory process as early as possible, prevent complications and induce mucosal healing. In the future, biological therapies for IBD are likely to be used more selectively based on personalised benefit/risk assessment, determined through reliable biomarkers and tissue signatures, and will probably be optimised throughout the course of treatment. Biologics with different mechanisms of action will be available; when one drug fails, patients will be able to switch to another and even combination biologics may become a reality. The role of biotherapeutic products that are similar to currently licensed biologics in terms of quality, safety and efficacy - i.e. biosimilars - is at an early stage and requires further experience. Other therapeutic strategies may involve manipulation of the microbiome using antibiotics, probiotics, prebiotics, diet and combinations of all these approaches. Faecal microbiota transplantation is also a potential option in IBD although controlled data are lacking.
The future of classifying, prognosticating and managing IBD involves an outcomes-based approach to identify biomarkers reflecting various biological processes that can be matched with clinically important endpoints.
随着我们对炎症性肠病（IBD）病理生理学的认识不断扩展，IBD的临床管理、新治疗模式以及个性化医疗的潜在影响仍然是备受关注的话题。
基于近期的临床前和临床研究，讨论了IBD管理未来可能的策略。
对于具有严重炎症风险因素或疾病进程不利的患者，越来越多地采用自上而下的药物治疗方法，试图尽早停止炎症过程、预防并发症并诱导黏膜愈合。未来，IBD的生物疗法可能会根据通过可靠的生物标志物和组织特征确定的个性化获益/风险评估更有选择性地使用，并且可能会在整个治疗过程中进行优化。将有不同作用机制的生物制剂可供使用；当一种药物无效时，患者将能够改用另一种药物，甚至联合生物制剂可能会成为现实。在质量、安全性和疗效方面与目前已获许可的生物制剂相似的生物治疗产品——即生物类似药——的作用尚处于早期阶段，需要更多经验。其他治疗策略可能包括使用抗生素、益生菌、益生元、饮食以及所有这些方法的组合来操纵微生物群。粪便微生物群移植在IBD中也是一种潜在选择，尽管缺乏对照数据。
IBD分类、预后和管理的未来涉及一种基于结果的方法，以识别反映各种生物学过程的生物标志物，这些生物标志物可与临床重要终点相匹配。
