Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Gastroenterology unit, Cochin University Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Aliment Pharmacol Ther. 2018 Apr;47(7):896-905. doi: 10.1111/apt.14550. Epub 2018 Feb 12.
Increased knowledge of pathways involved in the pathogenesis of IBD has led to the development of new treatment options for Crohn's disease (CD) and ulcerative colitis (UC). Two new biological agents have been recently approved for IBD: vedolizumab and ustekinumab. They have different therapeutic targets (α β integrin for vedolizumab and interleukin-12/23 pathways for ustekinumab) than the primary biological class, anti-tumour necrosis factor alpha (anti-TNF) agents. As the armamentarium for IBD increases in coming years, it will become important to understand factors associated with response in order to best position and personalise therapy.
To summarise the current data on predictors of response to vedolizumab and ustekinumab in IBD patients.
We conducted a comprehensive literature review. A PubMed search was performed using pre-defined key words and terms to identify relevant studies on predictors of response.
Patients with severe disease (by clinical activity and inflammatory biomarkers), or prior anti-TNF exposure are less likely to respond to vedolizumab. Ileocolonic disease, no prior surgery and uncomplicated phenotype were associated with better responses to ustekinumab in CD. Initial response seems to predict a better long-term maintenance in both therapies (P < 0.001). Contrary to anti-TNF therapies, immunogenicity appears to play less of a role in response.
As the number of new biological therapies increase in IBD, identifying patients who are most likely to benefit from specific agents is of paramount importance to help best position IBD therapies.
对炎症性肠病发病机制中涉及的途径的了解增加，导致了克罗恩病（CD）和溃疡性结肠炎（UC）的新治疗选择的发展。两种新的生物制剂最近已被批准用于治疗 IBD：vedolizumab 和 ustekinumab。它们与主要的生物制剂（抗肿瘤坏死因子-α（anti-TNF）药物）具有不同的治疗靶点（vedolizumab 为 αβ整合素，ustekinumab 为白细胞介素-12/23 途径）。随着未来几年 IBD 的治疗手段不断增加，了解与反应相关的因素以最佳定位和个性化治疗将变得非常重要。
总结目前关于 vedolizumab 和 ustekinumab 在 IBD 患者中反应预测因素的相关数据。
我们进行了全面的文献综述。通过使用预定义的关键词和术语在 PubMed 上进行了搜索，以确定关于反应预测因素的相关研究。
疾病严重程度（通过临床活动和炎症生物标志物评估）或先前抗 TNF 暴露的患者不太可能对 vedolizumab 有反应。CD 患者中，回结肠疾病、无先前手术史和无并发症表型与 ustekinumab 更好的反应相关。初始反应似乎预测两种治疗方法的长期维持更好（P<0.001）。与抗 TNF 治疗相反，免疫原性似乎在反应中作用较小。
随着 IBD 中新型生物治疗的数量增加，确定最有可能从特定药物中获益的患者对于帮助最佳定位 IBD 治疗至关重要。
