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游戏规则改变者:Janus 激酶抑制剂如何重塑溃疡性结肠炎治疗格局。

Game changer: How Janus kinase inhibitors are reshaping the landscape of ulcerative colitis management.

机构信息

Department of Gastroenterology and Hepatology, San Cecilio University Hospital, Granada 18014, Spain.

Department of Nursing, Faculty of Health Sciences, University of Granada, Granada 18004, Spain.

出版信息

World J Gastroenterol. 2024 Sep 21;30(35):3942-3953. doi: 10.3748/wjg.v30.i35.3942.

Abstract

Recent advancements in the treatment landscape of ulcerative colitis (UC) have ushered in a new era of possibilities, particularly with the introduction of Janus kinase (JAK)-signal transducer and activator of transcription inhibitors. These novel agents offer a paradigm shift in UC management by targeting key signaling pathways involved in inflammatory processes. With approved JAK inhibitors (JAKis), such as tofacitinib, filgotinib, and upadacitinib, clinicians now have powerful tools to modulate immune responses and gene expression, potentially revolutionizing the treatment algorithm for UC. Clinical trials have demonstrated the efficacy of JAKis in inducing and maintaining remission, presenting viable options for patients who have failed conventional therapies. Real-world data support the use of JAKis not only as first-line treatments but also in subsequent lines of therapy, particularly in patients with aggressive disease phenotypes or refractory to biologic agents. The rapid onset of action and potency of JAKis have broadened the possibilities in the management strategies of UC, offering timely relief for patients with active disease and facilitating personalized treatment approaches. Despite safety concerns, including cardiovascular risks and infections, ongoing research and post-marketing surveillance will continue to refine our understanding of the risk-benefit profile of JAKis in UC management.

摘要

近年来,溃疡性结肠炎(UC)治疗领域的进展开创了一个新的可能时代,尤其是引入了 Janus 激酶(JAK)-信号转导和转录激活因子抑制剂。这些新型药物通过靶向参与炎症过程的关键信号通路,在 UC 管理中实现了范式转变。有了已批准的 JAK 抑制剂(JAKi),如托法替尼、非戈替尼和乌帕替尼,临床医生现在拥有了调节免疫反应和基因表达的强大工具,可能彻底改变 UC 的治疗算法。临床试验表明 JAKi 在诱导和维持缓解方面的疗效,为那些对传统治疗方法失败的患者提供了可行的选择。真实世界的数据支持 JAKi 不仅作为一线治疗药物,而且在后续治疗线中使用,特别是在具有侵袭性疾病表型或对生物制剂耐药的患者中。JAKi 的快速作用和效力拓宽了 UC 管理策略的可能性,为患有活动期疾病的患者提供了及时的缓解,并促进了个体化的治疗方法。尽管存在安全性问题,包括心血管风险和感染,但正在进行的研究和上市后监测将继续深化我们对 JAKi 在 UC 管理中风险-效益特征的理解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fb3c/11438661/d2dfb44b520d/WJG-30-3942-g001.jpg

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