Yamamoto-Furusho Jesus K
Inflammatory Bowel Disease Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Curr Opin Gastroenterol. 2018 Jul;34(4):187-193. doi: 10.1097/MOG.0000000000000444.
Treatment of inflammatory bowel disease (IBD) patients can vary depending on the degree of response, lack of response or intolerance to conventional or biological agents aimed at blocking various cytokines or integrins. Recent therapies targeting several cytokines were reviewed to evaluate efficacy in IBD patients.
Ustekinumab is an interleukin inhibitor which blocks the p40 subunit of IL-12 and IL-23 axis and is already approved for the treatment of Crohn's disease patients, specially those who had inadequate response or intolerance to conventional treatment with anti-TNF-α agents. Several treatments have been developed that are focused on the blockade of specific cytokines such as IL-6, IL-12, IL-13, IL-17, IL-23 and a chemokine named IFN-γ-inducible protein-10 as well as some oral small-molecule inhibitors of intracellular cytoplasmic tyrosine kinases like tofacitinib, filgotinib and upadacitinib.
Several biologics blocking different and specific cytokines and oral small molecule agents have been and are being evaluated in IBD patients. A comprehensive understanding of the underlying immunological mechanisms will allow to develop effective and safe agents that inhibit one or more cytokines to improve the outcome in patients with IBD.
炎症性肠病（IBD）患者的治疗会因对旨在阻断各种细胞因子或整合素的传统或生物制剂的反应程度、无反应或不耐受而有所不同。对近期针对多种细胞因子的疗法进行了综述，以评估其在IBD患者中的疗效。
乌司奴单抗是一种白细胞介素抑制剂，可阻断IL-12和IL-23轴的p40亚基，已被批准用于治疗克罗恩病患者，特别是那些对传统抗TNF-α药物治疗反应不足或不耐受的患者。已经开发了几种专注于阻断特定细胞因子的治疗方法，如IL-6、IL-12、IL-13、IL-17、IL-23和一种名为IFN-γ诱导蛋白-10的趋化因子，以及一些细胞内细胞质酪氨酸激酶的口服小分子抑制剂，如托法替布、非戈替尼和乌帕替尼。
几种阻断不同特定细胞因子的生物制剂和口服小分子药物已在IBD患者中进行评估，并正在进行评估。对潜在免疫机制的全面理解将有助于开发有效且安全的药物，抑制一种或多种细胞因子，以改善IBD患者的预后。
