Wetwittayakhlang Panu, Lakatos Peter L
Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC, Canada.
Therap Adv Gastroenterol. 2024 Oct 24;17:17562848241272995. doi: 10.1177/17562848241272995. eCollection 2024.
Current therapeutic strategies for inflammatory bowel disease (IBD) have reached a plateau in the rates of response and/or remission achieved with a single therapeutic agent. Consequently, the advanced combination therapy (ACT) strategy has emerged as a novel treatment concept for IBD. ACT involves the use of two different targeted therapies, whether biologic or small molecules, with the primary goal of overcoming the therapeutic plateau. Real-world evidence is accumulating among patients undergoing ACT, especially those dealing with concurrent IBD and extraintestinal manifestations or grappling with medically refractory IBD. The recently conducted VEGA study, a randomized clinical trial, has provided crucial insights by demonstrating that the short-term combination of dual biological agents can lead to superior disease control compared to single agents in patients diagnosed with ulcerative colitis (UC). This suggests that ACT holds promise as a therapeutic option to enhance disease control effectively. However, there is still limited evidence of ACT in UC patients who have proven refractory to biologic therapy and patients with Crohn's disease. This review aims to discuss whether ACT represents the optimal approach for overcoming the therapeutic ceiling in IBD.
炎症性肠病（IBD）的当前治疗策略在单一治疗药物所达到的缓解率和/或缓解程度方面已达到平台期。因此，先进联合治疗（ACT）策略已成为IBD的一种新型治疗理念。ACT涉及使用两种不同的靶向治疗，无论是生物制剂还是小分子药物，其主要目标是克服治疗平台期。在接受ACT治疗的患者中，尤其是那些同时患有IBD和肠外表现或患有药物难治性IBD的患者，真实世界的证据正在积累。最近进行的VEGA研究是一项随机临床试验，通过证明在诊断为溃疡性结肠炎（UC）的患者中，双生物制剂的短期联合使用比单一药物能带来更好的疾病控制，提供了关键见解。这表明ACT有望成为有效增强疾病控制的一种治疗选择。然而，对于对生物治疗已证明无效的UC患者和克罗恩病患者，ACT的证据仍然有限。本综述旨在讨论ACT是否代表克服IBD治疗上限的最佳方法。
