Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
BMJ. 2017 Jun 19;357:j2505. doi: 10.1136/bmj.j2505.
The treatment of inflammatory bowel disease (IBD)-ulcerative colitis (UC) and Crohn's disease (CD)-has evolved beyond surgery with the introduction of biologic agents, primarily antibodies against mediators of inflammation and cell attraction. Anti-tumor necrosis factor (TNF) agents have been the first line treatment for moderate to severe ulcerative colitis and Crohn's disease for more than 15 years. During that time much has been learnt about how best to use these agents. This review will assess the evidence on how to optimize the use of anti-TNF agents; when and how to start treatment; how to monitor treatment and when to de-escalate it; and the potential adverse effects of these drugs. New and emerging treatments such as anti-attractants, anti-interleukins, and Janus kinase (JAK) inhibitors will also be discussed.
炎症性肠病（IBD）-溃疡性结肠炎（UC）和克罗恩病（CD）的治疗已经超越了手术，引入了生物制剂，主要是针对炎症介质和细胞趋化因子的抗体。抗肿瘤坏死因子（TNF）制剂已经成为中重度溃疡性结肠炎和克罗恩病 15 年以上的一线治疗药物。在这段时间里，人们已经了解了如何最好地使用这些药物。这篇综述将评估如何优化抗 TNF 制剂的使用的证据；何时以及如何开始治疗；如何监测治疗以及何时降低其剂量；以及这些药物的潜在不良反应。还将讨论新出现的治疗方法，如抗趋化因子、抗白细胞介素和 Janus 激酶（JAK）抑制剂。
