Dai Cong, Huang Yu-Hong, Jiang Min
Department of Gastroenterology, First Hospital of China Medical University, Shenyang City, Liaoning Province, China.
Department of Gastroenterology, First Hospital of China Medical University, Shenyang City, Liaoning Province, China.
Int Immunopharmacol. 2023 Jan;114:109545. doi: 10.1016/j.intimp.2022.109545. Epub 2022 Dec 9.
BACKGROUND AND OBJECTIVE: Inflammatory Bowel Diseases (IBD) are chronic nonspecific intestinal inflammatory diseases with a relapsing-remitting course, including Ulcerative Colitis (UC) and Crohn's Disease (CD). Combination therapy has been proposed as a strategy to enhance treatment efficacy in IBD. The aim of this study is to summarize current evidence and perspectives on combination therapies in IBD. METHODS: Electronic databases such as PubMed, Ovid Embase, Medline, and Cochrane CENTRAL were searched to identify relevant studies. RESULTS: Current evidence supports that the combination of infliximab and thiopurines is more effective than monotherapy in inducing and maintaining remission in IBD. Data on the combination of other biological agents such as adalimumab, vedolizumab, ustekinumab, and immunosuppressors is lacking or showed conflicting results. Vedolizumab seems a potentially effective maintenance regimen after calcineurin inhibitors-based rescue therapy in acute severe ulcerative colitis (ASUC). Dual Targeted Therapy, which is the combination of two biological agents and/or small molecules, might be a reasonable choice in patients with concomitant IBD and extraintestinal manifestations, or in patients with medical-refractory IBD who lack valid alternatives. Some safety concerns such as adverse events (serious and opportunistic infections) and malignancies (lymphoma and nonmelanoma skin cancer) were raised in combination therapies. CONCLUSIONS: Combination therapies seem to be effective in some IBD patients such as refractory IBD patients or patients with extraintestinal manifestations, but it might be associated with an increased risk of adverse events and malignancies.
背景与目的:炎症性肠病(IBD)是一类慢性非特异性肠道炎症性疾病,呈复发 - 缓解病程,包括溃疡性结肠炎(UC)和克罗恩病(CD)。联合治疗已被提出作为提高IBD治疗效果的一种策略。本研究旨在总结IBD联合治疗的现有证据和观点。 方法:检索电子数据库,如PubMed、Ovid Embase、Medline和Cochrane CENTRAL,以确定相关研究。 结果:现有证据支持英夫利昔单抗和硫嘌呤联合使用在诱导和维持IBD缓解方面比单一疗法更有效。关于阿达木单抗、维多珠单抗、乌司奴单抗等其他生物制剂与免疫抑制剂联合使用的数据缺乏或结果相互矛盾。在急性重度溃疡性结肠炎(ASUC)中,基于钙调神经磷酸酶抑制剂的挽救治疗后,维多珠单抗似乎是一种潜在有效的维持治疗方案。双靶点治疗,即两种生物制剂和/或小分子的联合,对于合并IBD和肠外表现的患者,或缺乏有效替代方案的难治性IBD患者可能是一个合理的选择。联合治疗引发了一些安全问题,如不良事件(严重和机会性感染)和恶性肿瘤(淋巴瘤和非黑色素瘤皮肤癌)。 结论:联合治疗在一些IBD患者中似乎是有效的,如难治性IBD患者或有肠外表现的患者,但可能与不良事件和恶性肿瘤风险增加有关。
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