Division of Gastroenterology and Hepatology, American University of Beirut, Beirut, Lebanon.
Curr Opin Gastroenterol. 2021 Jul 1;37(4):351-356. doi: 10.1097/MOG.0000000000000735.
Since there is a lack of head-to-head randomized controlled trials, little direction is provided from guidelines on the positioning of biologics for the treatment of Crohn's disease (CD). This review utilizes comparative effectiveness and safety results from real-world data and network meta-analyses to inform clinical practice for positioning of biological therapies in the treatment of moderate-to-severe CD.
We summarize the results of studies pertaining to the identification of predictors for response to biologics in CD. Recently published studies about the management of moderate-to-severe CD are discussed and a positioning algorithm is proposed for the therapeutic approach of these patients.
Different classes of biologics are comparable with regards to safety and almost similar in effectiveness in the management of CD. There are certain clinical scenarios in which one biologic is more effective than another. For instance, patients with a more aggressive disease phenotype such as fistulizing disease would benefit from infliximab over other biologics, whereas in older patients at a higher risk for infectious complications, it may be more appropriate to use ustekinumab or vedolizumab over the anti-tumor necrosis factor (TNF) agents. More data pertaining to identifying predictors of response to the different available therapies and head-to-head comparison trials are needed to personalize our therapeutic approach of CD patients.
由于缺乏头对头的随机对照试验，指南在指导生物制剂治疗克罗恩病（CD）的定位方面提供的指导有限。本综述利用真实世界数据和网络荟萃分析的比较效果和安全性结果，为生物治疗在中重度 CD 治疗中的定位提供临床实践信息。
我们总结了与 CD 中生物制剂反应预测因子相关的研究结果。讨论了最近发表的关于中重度 CD 管理的研究，并提出了这些患者治疗方法的定位算法。
不同类别的生物制剂在安全性方面具有可比性，在 CD 的治疗效果方面也几乎相同。在某些临床情况下，一种生物制剂比另一种更有效。例如，具有侵袭性疾病表型（如瘘管性疾病）的患者可能从英夫利昔单抗中获益，而对于感染并发症风险较高的老年患者，使用乌司奴单抗或维得利珠单抗可能比抗 TNF 药物更合适。需要更多的数据来确定不同可用治疗方法的反应预测因子，并进行头对头比较试验，以实现 CD 患者治疗方法的个体化。
