Fudman David I, McConnell Ryan A, Ha Christina, Singh Siddharth
Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Division of Gastroenterology, Palo Alto Medical Foundation, Palo Alto, California.
Clin Gastroenterol Hepatol. 2025 Feb;23(3):454-468. doi: 10.1016/j.cgh.2024.06.050. Epub 2024 Aug 13.
The therapeutic armamentarium for management of inflammatory bowel diseases has expanded dramatically in the last 5 years, with the introduction of several medications with different mechanisms of action. These include the oral small molecule drugs Janus kinase inhibitors (including upadacitinib, approved for Crohn's disease and ulcerative colitis [UC], and tofacitinib, approved for UC) and sphingosphine 1-phosphate receptor modulators (ozanimod and etrasimod, both approved for UC), and biologic agents, such as selective interleukin-23 antagonists (risankizumab approved for Crohn's disease, and mirikizumab approved for UC). The efficacy and safety of these therapies vary. In this review, we discuss practical use of these newer advanced therapies focusing on real-world effectiveness and safety data, dosing and monitoring considerations, and special situations for their use, such as pregnancy, comorbid immune-mediated disease, use in hospitalized patients with acute severe UC, and in the perioperative setting. We also propose our approach to positioning these therapies in clinical practice, relying on careful integration of the medication's comparative effectiveness and safety in the context of an individual patient's risk of disease- and treatment-related complications and preferences.
在过去5年中，随着多种作用机制不同的药物问世，用于治疗炎症性肠病的治疗手段有了显著扩展。这些药物包括口服小分子药物，如Janus激酶抑制剂（包括已获批用于治疗克罗恩病和溃疡性结肠炎[UC]的乌帕替尼，以及已获批用于治疗UC的托法替布）和鞘氨醇-1-磷酸受体调节剂（奥扎莫德和艾曲莫德，均已获批用于治疗UC），还有生物制剂，如选择性白细胞介素-23拮抗剂（已获批用于治疗克罗恩病的瑞莎珠单抗，以及已获批用于治疗UC的mirikizumab）。这些疗法的疗效和安全性各不相同。在本综述中，我们将讨论这些新型先进疗法的实际应用，重点关注真实世界中的有效性和安全性数据、给药和监测注意事项，以及它们在特殊情况下的使用，如妊娠、合并免疫介导疾病、用于急性重度UC住院患者以及围手术期。我们还提出了在临床实践中应用这些疗法的方法，这依赖于在个体患者发生疾病及治疗相关并发症的风险和偏好背景下，仔细整合药物的相对有效性和安全性。
