a The Henry D. Janowitz Division of Gastroenterology , One Gustave L. Levy Place , New York , NY , USA.
b Gastroenterology Service , Centre Hospitalier de l'Université de Montréal (CHUM) , Montreal , Quebec , Canada.
Expert Rev Gastroenterol Hepatol. 2018 Nov;12(11):1101-1108. doi: 10.1080/17474124.2018.1530983. Epub 2018 Oct 10.
Crohn's disease and Ulcerative Colitis are forms of inflammatory bowel disease (IBD), chronic diseases treated with medical and surgical therapy. Patients with IBD are treated with potent immunomodulatory agents, leading to immunosuppression, and the potential for opportunistic infections. In 2014, the ECCO guidelines were released to guide the prevention, diagnosis and treatment of a variety of these opportunistic infections. Since 2014, there have been a number of new agents released as well as a significant expansion in our knowledge of the safety profile of IBD medications. In this article, we review the literature after 2014 regarding opportunistic infections and updates on safety data. Areas covered: We review updates in immunomodulatory therapies for IBD and opportunistic infections since the 2014 ECCO guidelines were published. Expert commentary: The prevention, diagnosis, and treatment of opportunistic infections continue to evolve, as new drugs are approved, and the use of a combination of biologic agents are considered for therapy in clinical trials. What causes some patients to fail to respond to vaccination, or for others to develop severe infections, remains unclear. Improved risk stratification for opportunistic infections in IBD patients and updated ECCO 2014 guidelines would be of significant benefit.
克罗恩病和溃疡性结肠炎是炎症性肠病 (IBD) 的两种形式，采用医学和手术治疗。IBD 患者接受强效免疫调节剂治疗，导致免疫抑制和机会性感染的潜在风险。2014 年，ECCO 指南发布，旨在指导各种机会性感染的预防、诊断和治疗。自 2014 年以来，已经有许多新的药物上市，并且我们对 IBD 药物的安全性有了更深入的了解。本文回顾了 2014 年以后关于机会性感染和安全性数据更新的文献。涵盖领域：我们回顾了 2014 年 ECCO 指南发布后 IBD 免疫调节治疗和机会性感染的更新。专家评论：随着新药的批准以及临床试验中考虑联合使用生物制剂进行治疗，机会性感染的预防、诊断和治疗仍在不断发展。一些患者对疫苗接种无反应或发生严重感染的原因仍不清楚。改善 IBD 患者的机会性感染风险分层和更新的 ECCO 2014 指南将具有重要意义。
