Johnson Christopher M, Linzay Catherine D, Dassopoulos Themistocles
Baylor Scott and White Medical Center, Baylor Scott and White Health, Temple, TX, USA.
Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA.
Curr Gastroenterol Rep. 2019 Sep 5;21(10):52. doi: 10.1007/s11894-019-0716-3.
Recent years have brought about several advances in the treatment of patients with ulcerative colitis (UC). Here, we discuss salient recommendations of recent treatment guidelines; review the efficacy, safety, and real-world data of vedolizumab and tofacitinib; appraise their place vis-à-vis established agents; and consider the newly proposed approaches of risk-stratified and treat-to-target therapy.
Once daily oral mesalamine dosing is equivalent to split dosing in mild-moderate UC. Real-world data are accumulating on the effectiveness and safety of vedolizumab for moderate to severe UC, while there are few such data on the most recently approved agent, tofacitinib. High-dose infliximab is being investigated for severe UC. New approaches are challenging the established paradigm of selecting therapy based on current disease activity. The risk-stratified approach incorporates long-term risk as well as the current burden of inflammation. The treat-to-target approach aims at improved long-term outcomes by adjusting therapy to resolve intestinal inflammation. The therapeutic options for UC are continually expanding. Risk-stratified therapy and the treat-to-target approach represent paradigm shifts in UC management. Optimal disease control requires an individualized approach that takes into consideration current inflammatory burden, long-term risk, patient preferences, and ongoing assessment of response to treatment.
近年来，溃疡性结肠炎（UC）患者的治疗取得了多项进展。在此，我们讨论近期治疗指南的重要建议；回顾维多珠单抗和托法替布的疗效、安全性及真实世界数据；评估它们与现有药物相比的地位；并考虑新提出的风险分层和达标治疗方法。
在轻至中度UC中，每日一次口服美沙拉嗪给药与分次给药等效。关于维多珠单抗治疗中重度UC的有效性和安全性的真实世界数据正在积累，而关于最新获批药物托法替布的此类数据较少。正在研究高剂量英夫利昔单抗治疗重度UC。新方法正在挑战基于当前疾病活动选择治疗的既定模式。风险分层方法纳入了长期风险以及当前的炎症负担。达标治疗方法旨在通过调整治疗以消除肠道炎症来改善长期结局。UC的治疗选择在不断扩展。风险分层治疗和达标治疗方法代表了UC管理模式的转变。最佳疾病控制需要个体化方法，该方法要考虑当前的炎症负担、长期风险、患者偏好以及对治疗反应的持续评估。
