State Monica, Negreanu Lucian
Department 5, Internal Medicine-Gastroenterology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Colentina Clinical Hospital, 020125 Bucharest, Romania.
Biomedicines. 2023 Feb 13;11(2):544. doi: 10.3390/biomedicines11020544.
The expansion of advanced therapies for inflammatory bowel disease created a lag between the development of these new therapies and their incorporation and use in daily practice. At present, no clear definitions for treatment optimization, treatment failure or criteria to abandon therapy are available. We aimed to centralize criteria for a nonresponse to all available molecules and to summarize guideline principles for treatment optimization.
We conducted a systematic review of studies that reported criteria for the treatment response to all advanced therapies (infliximab, adalimumab, golimumab, ustekinumab, vedolizumab and tofacitinib) in patients with inflammatory bowel disease.
Across trials, criteria for a response of both patients with ulcerative colitis and Crohn's disease are heterogenous. Investigators use different definitions for clinical and endoscopic remission, and endoscopic response and outcomes are assessed at variable time points. Current society guidelines provide heterogenous recommendations on treatment optimization. Most available data on loss of response concern anti-TNF molecules, and newer therapies are not included in the guidelines.
The lack of clear definitions and formal recommendations provide the premise for empirical treatment strategies and premature abandonment of therapies.
炎症性肠病的先进治疗方法不断扩展，导致这些新疗法的研发与日常临床应用和纳入之间存在滞后。目前，尚无关于治疗优化、治疗失败或停止治疗标准的明确界定。我们旨在集中所有可用药物无反应的标准，并总结治疗优化的指南原则。
我们对报告炎症性肠病患者对所有先进治疗方法（英夫利昔单抗、阿达木单抗、戈利木单抗、乌司奴单抗、维多珠单抗和托法替布）治疗反应标准的研究进行了系统评价。
在各项试验中，溃疡性结肠炎和克罗恩病患者的反应标准各不相同。研究人员对临床和内镜缓解采用不同的定义，且在内镜反应和结果评估的时间点也各不相同。当前的学会指南在治疗优化方面提供了各不相同的建议。大多数关于反应丧失的现有数据涉及抗TNF分子，而新疗法未被纳入指南。
缺乏明确的定义和正式建议为经验性治疗策略和过早放弃治疗提供了前提。
