Gomollón Fernando
Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Facultad de Medicina, IIS Aragón, CIBEREHD, Zaragoza, España.
Gastroenterol Hepatol. 2015 Sep;38 Suppl 1:13-9. doi: 10.1016/S0210-5705(15)30015-7.
In addition to immunosuppressive drugs and anti-TNF, there are a number of new options in the treatment of inflammatory bowel diseases. Vedolizumab has been approved by the FDA and EMA and has demonstrated utility both in the treatment of ulcerative colitis (UC) and Crohn's disease (CD), even in anti-TNF refractory patients. Other monoclonal antibodies with different targets such as PF-005447659 (antiMAd-CAM1), ustekinumab (anti-IL23/IL12) or MEDI2070 (anti-IL23) have shown promising results in distinct clinical scenarios. Mongersen (antisense oligonucleotide anti-Smad7) and oznimod (an SP-1 modulator) are new alternatives with proven efficacy in clinical trials in CD and UC, respectively. Some data suggest that faecal microbiota transplantation could be efficacious in individual patients, although controlled data do not show clear differences with placebo. Autologous stem-cell transplantation has shown long-term efficacy in "ultra-refractory" CD. The number of possible treatments is constantly increasing, and future research should focus both on the selection of the most appropriate treatment for any given patient and on comparative trials between options.
除免疫抑制药物和抗TNF药物外，炎症性肠病的治疗还有许多新选择。维多珠单抗已获美国食品药品监督管理局（FDA）和欧洲药品管理局（EMA）批准，在溃疡性结肠炎（UC）和克罗恩病（CD）的治疗中均显示出疗效，甚至对难治性抗TNF患者也有效。其他具有不同靶点的单克隆抗体，如PF-005447659（抗MAd-CAM1）、优特克单抗（抗IL23/IL12）或MEDI2070（抗IL23），在不同临床场景中均显示出有前景的结果。蒙吉森（反义寡核苷酸抗Smad7）和奥兹尼莫德（一种SP-1调节剂）分别是在CD和UC临床试验中已证实有效的新选择。一些数据表明，粪便微生物群移植对个别患者可能有效，尽管对照数据未显示与安慰剂有明显差异。自体干细胞移植在“超难治性”CD中已显示出长期疗效。可能的治疗方法数量在不断增加，未来的研究应既关注为任何特定患者选择最合适的治疗方法，也关注不同治疗选择之间的对比试验。
