Department of Medicine 1, Kussmaul Campus for Medical Research, Ludwig Demling Endoscopy Center of Excellence, Ulmenweg 18, University of Erlangen-Nürnberg, 91054 Erlangen, Germany.
Nat Rev Gastroenterol Hepatol. 2017 May;14(5):269-278. doi: 10.1038/nrgastro.2016.208. Epub 2017 Feb 1.
Various therapeutic advances have led to a paradigm shift in the clinical management of patients with IBD. The introduction of immunosuppressive (such as azathioprine) and biologic agents (such as TNF blockers) has markedly reduced the need to use corticosteroids for therapy. Furthermore, the α4β7 integrin blocker vedolizumab has been introduced for clinical IBD therapy. Moreover, various new inhibitors of cytokines (for example, IL-6-IL-6R and IL-12-IL-23 blockers or apremilast), modulators of cytokine signalling events (for example, JAK inhibitors or SMAD7 blocker), inhibitors of transcription factors (for example, GATA3 or RORγt) and new anti-adhesion and anti-T-cell-activation and migration strategies (for example, β7 integrin, sphingosine 1-phosphate receptors and MAdCAM1 inhibitors, regulatory T-cell therapy and stem cells) are currently being evaluated in controlled clinical trials. This Review aims to provide a comprehensive overview about current and future therapeutic approaches for IBD therapy. Furthermore, potential mechanisms of action of these therapeutic approaches and their implications for clinical therapy in IBD are discussed.
各种治疗进展导致了 IBD 患者临床管理的范式转变。免疫抑制剂(如硫唑嘌呤)和生物制剂(如 TNF 阻滞剂)的引入显著减少了对皮质类固醇治疗的需求。此外,α4β7 整合素抑制剂vedolizumab 已被引入用于临床 IBD 治疗。此外,目前正在对照临床试验中评估各种新的细胞因子抑制剂(例如,IL-6-IL-6R 和 IL-12-IL-23 阻滞剂或 apremilast)、细胞因子信号事件调节剂(例如,JAK 抑制剂或 SMAD7 阻滞剂)、转录因子抑制剂(例如,GATA3 或 RORγt)和新的抗黏附、抗 T 细胞激活和迁移策略(例如,β7 整合素、鞘氨醇 1-磷酸受体和 MAdCAM1 抑制剂、调节性 T 细胞治疗和干细胞)。这篇综述旨在全面概述 IBD 治疗的当前和未来治疗方法。此外,还讨论了这些治疗方法的潜在作用机制及其对 IBD 临床治疗的影响。