Yzet Clare, Brazier Franck, Sabbagh Charles, Fumery Mathurin
Gastroenterology Unit, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.
Digestive Surgery Unit, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.
Curr Res Pharmacol Drug Discov. 2022 Jan 13;3:100081. doi: 10.1016/j.crphar.2022.100081. eCollection 2022.
Crohn's disease is a chronic inflammatory bowel disease that affects various intestinal segments and can involve the perianal region. Although anti-tumor necrosis factor (TNF) agents have revolutionized the management of Crohn's disease and improved the prognosis for patients with perianal Crohn's disease (pCD), their long-term effectiveness is limited: over 60% of patients relapse after one year of maintenance therapy. In recent years, significant advances have been made in the treatment of complex perianal fistulas after anti-TNF failure. Concomitant treatment with antibiotics and immunosuppressants improves the effectiveness of anti-TNF agents. Therapeutic drug monitoring and dose adjustment of anti-TNF therapy (targeting a higher trough level) might also improve treatment response. Novel therapeutic strategies might provide new opportunities for pCD management; for example, ustekinumab might be effective after anti-TNF treatment failure, although more studies are needed. As suggested in recent international guidelines, mesenchymal stem cell injection might be an effective, safe treatment for complex pCD.
克罗恩病是一种慢性炎症性肠病，可累及肠道各段，且可累及肛周区域。尽管抗肿瘤坏死因子（TNF）药物彻底改变了克罗恩病的治疗方式，并改善了肛周克罗恩病（pCD）患者的预后，但其长期疗效有限：超过60%的患者在维持治疗一年后复发。近年来，抗TNF治疗失败后复杂肛周瘘管的治疗取得了重大进展。联合使用抗生素和免疫抑制剂可提高抗TNF药物的疗效。抗TNF治疗的治疗药物监测和剂量调整（以更高的谷浓度为目标）也可能改善治疗反应。新型治疗策略可能为pCD的管理提供新机会；例如，乌司奴单抗在抗TNF治疗失败后可能有效，不过还需要更多研究。正如近期国际指南所建议的，间充质干细胞注射可能是治疗复杂pCD的一种有效、安全的方法。
