Samaan Mark, Campbell Samantha, Cunningham Georgina, Tamilarasan Aravind Gokul, Irving Peter M, McCartney Sara
Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.
Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK.
F1000Res. 2019 Jul 29;8. doi: 10.12688/f1000research.18902.1. eCollection 2019.
The era of biologic agents for the treatment of Crohn's disease has brought about significant benefits for patients, and since the introduction of infliximab at the turn of the century, the entire field has moved on rapidly. Clinicians now have multiple agents at their disposal and a choice between several different anti-inflammatory mechanisms of action. This has allowed unprecedented improvements not only in symptoms and quality of life for patients previously refractory to conventional treatments but also for demonstrated healing of the intestinal mucosa and resolution of perianal fistulation. However, despite the undisputed efficacy of these agents, there remains a significant proportion of patients who fail to gain a meaningful benefit. Through years of studying infliximab and its counterpart anti-tumour necrosis factor (anti-TNF) agent, adalimumab, we now understand that strategies such as combining use with a conventional immunomodulator or measuring serum levels can help to optimise outcomes and reduce the proportion of patients for whom treatment fails. Work is ongoing to understand whether these principles apply to newer biologics such as vedolizumab and ustekinumab. In addition, novel approaches are being investigated in an attempt to maximise the benefit that these agents could offer. In this article, we summarise these new understandings and consider ways in which they could be integrated into clinical practice for the benefit of patients.
生物制剂治疗克罗恩病的时代给患者带来了显著益处，自世纪之交英夫利昔单抗问世以来，整个领域迅速发展。临床医生现在有多种药物可供选择，且可在几种不同的抗炎作用机制之间进行抉择。这不仅使先前对传统治疗无效的患者在症状和生活质量方面取得了前所未有的改善，还实现了肠黏膜愈合以及肛周瘘管的愈合。然而，尽管这些药物的疗效无可争议，但仍有相当一部分患者未能从中获得显著益处。通过多年对英夫利昔单抗及其同类抗肿瘤坏死因子（抗TNF）药物阿达木单抗的研究，我们现在明白，诸如与传统免疫调节剂联合使用或检测血清水平等策略有助于优化治疗效果，并减少治疗失败患者的比例。目前正在研究这些原则是否适用于维多珠单抗和乌司奴单抗等新型生物制剂。此外，正在探索新的方法，以最大限度地发挥这些药物的益处。在本文中，我们总结了这些新认识，并思考如何将它们整合到临床实践中以造福患者。
