Pagnini Cristiano, Pizarro Theresa T, Cominelli Fabio
Department of Gastroenterology and Digestive Endoscopy, S. Giovanni Addolorata Hospital, Rome, Italy.
Department of Medicine and Pathology, Case Western Reserve University, Digestive Health Institute, University Hospitals of Cleveland, Cleveland, OH, United States.
Front Pharmacol. 2019 Jun 18;10:671. doi: 10.3389/fphar.2019.00671. eCollection 2019.
Inflammatory bowel diseases (IBDs) are chronic conditions of the gastrointestinal tract in which dysregulated immune responses cause persistent inflammation of the gut mucosa. Biologic therapy with anti-TNF blockers has revolutionized the therapeutic management of IBD for their remarkable efficacy and potential impact on disease course and for many years has represented the sole treatment option for patients refractory or intolerant to conventional therapy. In recent years, more molecules, both biologically and chemically synthetized, have been developed as potential therapeutic options for IBD that target different molecular pathways aside from TNF blockade, and which have been proposed as targets for novel drugs. This is particularly relevant for the present, as well as future, management of IBD, considering that some patients are refractory to anti-TNF. This review will summarize the pharmacological options, either currently available or in the pipeline, for market approval to treat IBD, besides anti-TNF strategies, based on their mechanism(s) of action. We will also analyze the current evidence for effectiveness and safety, as well as offer perspective, regarding the potential implementation for such therapies in the future.
炎症性肠病(IBD)是胃肠道的慢性疾病,其中免疫反应失调会导致肠道黏膜持续炎症。使用抗TNF阻滞剂的生物疗法因其显著疗效以及对病程的潜在影响,彻底改变了IBD的治疗管理方式,多年来一直是对传统疗法难治或不耐受患者的唯一治疗选择。近年来,更多生物合成和化学合成的分子已被开发为IBD的潜在治疗选择,它们除了阻断TNF外,还靶向不同的分子途径,并被提议作为新药的靶点。鉴于一些患者对抗TNF治疗无效,这对于IBD目前以及未来的管理尤为重要。本综述将根据其作用机制,总结除抗TNF策略外,目前已上市或正在研发中、有望获得市场批准用于治疗IBD的药物选择。我们还将分析当前关于有效性和安全性的证据,并对这些疗法未来的潜在应用前景提供见解。