Misselwitz Benjamin, Zeißig Sebastian, Schreiber Stefan, Dignass Axel
Medizinische Klinik und Poliklinik II, LMU München, München, Deutschland.
Klinik für Innere Medizin A, Universitätsmedizin Greifswald, Greifswald, Deutschland.
Inn Med (Heidelb). 2025 Jan;66(1):3-14. doi: 10.1007/s00108-024-01833-w. Epub 2025 Jan 2.
The treatment options for chronic inflammatory bowel diseases (IBD) have been greatly expanded due to a better understanding of the underlying pathogenesis. A total of five classes of advanced treatment are available.
A practical overview of advanced treatment of IBD.
Narrative review.
Advanced treatments are indicated for moderate to severe IBD. A timely use is recommended to achieve better response rates and to avoid irreversible bowel damage. Tumor necrosis factor (TNF) inhibitors and Janus kinase (JAK) inhibitors have a broad efficacy, also for extraintestinal disease manifestations. The risk of reactivation of varicella zoster virus is increased with JAK inhibitors. In high-risk patients and an age >65 years there is possibly a moderately elevated cardiovascular risk and neoplastic side effects. The integrin alpha4beta7 inhibitor vedolizumab and the interleukin (IL) 12 and 23 inhibitor ustekinumab have very good safety profiles. Selective IL-23 inhibitors are sometimes superior to ustekinumab with comparable safety profiles with respect to efficacy. The sphingosine-1-phosphate receptor modulators ozanimod and etrasimod are approved for oral treatment of ulcerative colitis. The treatment success of the medications remains still limited and a minority of patients will not respond to every individual treatment. Thus, sequential administration of several treatments is often needed. Due to the lack of comparative studies, the personalized choice, sequence and decision for treatments are usually based on personal experience and should take patient preferences, efficacy, safety and individual patient profiles into consideration.
由于对慢性炎症性肠病（IBD）潜在发病机制有了更深入的了解，其治疗选择已得到极大扩展。共有五类先进治疗方法可供使用。
对IBD的先进治疗进行实用概述。
叙述性综述。
先进治疗适用于中度至重度IBD。建议及时使用以获得更好的缓解率并避免不可逆的肠道损伤。肿瘤坏死因子（TNF）抑制剂和Janus激酶（JAK）抑制剂具有广泛的疗效，对肠外疾病表现也有效。JAK抑制剂会增加水痘带状疱疹病毒再激活的风险。在高危患者和年龄>65岁的人群中，心血管风险和肿瘤副作用可能会适度升高。整合素α4β7抑制剂维多珠单抗以及白细胞介素（IL）12和23抑制剂乌司奴单抗具有非常好的安全性。选择性IL-23抑制剂在疗效方面有时优于乌司奴单抗，且安全性相当。鞘氨醇-1-磷酸受体调节剂奥扎莫德和艾曲莫德已被批准用于口服治疗溃疡性结肠炎。药物的治疗成功率仍然有限，少数患者对每种治疗都无反应。因此，通常需要依次使用几种治疗方法。由于缺乏比较研究，治疗的个性化选择、顺序和决策通常基于个人经验，应考虑患者偏好、疗效、安全性和患者个体情况。
