Strigáč Aleksandra, Caban Miłosz, Małecka-Wojciesko Ewa, Talar-Wojnarowska Renata
Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland.
Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, 92-215 Lodz, Poland.
J Clin Med. 2024 Aug 9;13(16):4678. doi: 10.3390/jcm13164678.
The management of inflammatory bowel diseases (IBD) requires weighing an individual patient's therapeutic benefits and therapy-related complication risks. The immunomodulators that have been commonly used so far in IBD therapy are thiopurines, including 6-mercaptopurine and azathioprine. As our understanding of the IBD pathomechanisms is widening, new therapeutic approaches are being introduced, including the Janus kinase (JAK) inhibitors and Sphingosine 1-phosphate receptor (S1PR) modulators' development. Non-selective JAK inhibitors are represented by tofacitinib, while selective JAK inhibitors comprise filgotinib and upadacitinib. As for the S1PR modulators, ozanimod and etrasimod are approved for UC therapy. The number of elderly patients with IBD is growing; therefore, this review aimed to evaluate the effectiveness and safety of the oral immunomodulators among the subjects aged ≥60. Possible complications limit the use of thiopurines in senior patients. Likewise, the promising effectiveness of new drugs in IBD therapy in those with additional risk factors might be confined by the risk of serious adverse events. However, the data regarding this issue are limited.
炎症性肠病（IBD）的管理需要权衡个体患者的治疗益处和治疗相关并发症风险。迄今为止，IBD治疗中常用的免疫调节剂是硫唑嘌呤类药物，包括6-巯基嘌呤和硫唑嘌呤。随着我们对IBD发病机制的理解不断深入，新的治疗方法不断涌现，包括Janus激酶（JAK）抑制剂的研发以及1-磷酸鞘氨醇受体（S1PR）调节剂的开发。非选择性JAK抑制剂以托法替布为代表，而选择性JAK抑制剂包括非戈替尼和乌帕替尼。至于S1PR调节剂，奥扎莫德和艾曲莫德已获批用于UC治疗。IBD老年患者的数量正在增加；因此，本综述旨在评估年龄≥60岁的受试者口服免疫调节剂的有效性和安全性。可能出现的并发症限制了硫唑嘌呤类药物在老年患者中的使用。同样，在有其他风险因素的患者中，新药在IBD治疗中的显著疗效可能会受到严重不良事件风险的限制。然而，关于这个问题的数据有限。
