Khanna Reena, Mosli Mahmoud H, Feagan Brian G
Department of Medicine, University of Western Ontario, London, Ont., Canada.
Dig Dis. 2016;34(1-2):153-9. doi: 10.1159/000443132. Epub 2016 Mar 16.
Inflammatory bowel diseases (IBD) are a group of heterogeneous conditions, characterized by immune-mediated inflammation of the gastrointestinal tract. Traditionally, medical management of these disorders has been based on use of systemic immunosuppressives. The development of new drugs that selectively inhibit leukocyte trafficking to the gut has the potential to reduce inflammation and minimize systemic toxicities.
In this article, we review the immunology of the gut and the mechanism of action these emerging therapies for IBD. Natalizumab, a monoclonal antibody to the α4 integrin, was approved for the treatment of multiple sclerosis and showed promise in Crohn's disease (CD), however it is encumbered by the risk of progressive multifocal leukoencephalopathy. Vedolizumab inhibits the α4β7 integrin to induce clinical remission in patients with both ulcerative colitis and CD. Long-term safety data on this agent is not yet available. We also review agents in the pipeline. Finally, we discuss the positioning of therapies and potential alterations to therapeutic algorithms as new medications emerge.
New therapies are emerging for IBD; however, long-term data are pending. The positioning of these agents in algorithms will evolve.
炎症性肠病（IBD）是一组异质性疾病，其特征为胃肠道的免疫介导性炎症。传统上，这些疾病的药物治疗基于全身性免疫抑制剂的使用。选择性抑制白细胞向肠道迁移的新药研发，有可能减轻炎症并将全身毒性降至最低。
在本文中，我们综述了肠道免疫学以及这些新兴的IBD治疗方法的作用机制。那他珠单抗是一种针对α4整合素的单克隆抗体，已被批准用于治疗多发性硬化症，并在克罗恩病（CD）中显示出前景，然而它存在进行性多灶性白质脑病的风险。维得利珠单抗抑制α4β7整合素，可诱导溃疡性结肠炎和CD患者实现临床缓解。关于该药物的长期安全性数据尚未可得。我们还综述了正在研发中的药物。最后，随着新药物的出现，我们讨论了治疗方法的定位以及治疗方案可能的改变。
IBD正在出现新的治疗方法；然而，长期数据尚待完善。这些药物在治疗方案中的定位将会演变。
