Santonicola Antonella, Soldaini Carlo, Ciacci Carolina
Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
Curr Opin Gastroenterol. 2025 May 1;41(3):124-131. doi: 10.1097/MOG.0000000000001080. Epub 2025 Jan 27.
Celiac disease (CeD) is a chronic autoimmune disorder of the small intestine triggered by gluten ingestion in genetically predisposed individuals. The cornerstone of CeD management remains a strict adherence to a lifelong gluten-free diet (GFD), although such a dietary restriction can lead to an altered quality of life and may not be easy to follow for many patients. These challenges highlighted the need for alternative therapies. This review aims to explore the latest advancements in these therapeutic avenues, emphasizing mechanisms of action, clinical efficacy, and safety profiles of drugs currently in advanced stages of clinical testing.
Recent advances in the understanding of CeD pathophysiology have catalyzed the development of new therapeutic approaches, which include strategies to modify gluten processing in the gut, block gluten-triggered immune responses, or restore immune tolerance to gluten.
While these therapies are not poised to take the place of GFD, they represent promising treatment alternatives that could enhance the quality of life and minimize long-term consequences in CeD patients. Further research, as well as phase III clinical trials of those already conducted, are needed to establish the feasibility of integrating these novel drugs in the clinical management of CeD.
乳糜泻（CeD）是一种由遗传易感性个体摄入麸质引发的小肠慢性自身免疫性疾病。尽管严格坚持终身无麸质饮食（GFD）仍是CeD管理的基石，但这种饮食限制可能会导致生活质量下降，而且许多患者难以长期坚持。这些挑战凸显了替代疗法的必要性。本综述旨在探讨这些治疗途径的最新进展，重点关注处于临床试验后期阶段药物的作用机制、临床疗效和安全性。
对CeD病理生理学理解的最新进展推动了新治疗方法的开发，这些方法包括改变肠道中麸质处理方式、阻断麸质引发的免疫反应或恢复对麸质的免疫耐受等策略。
虽然这些疗法不会取代GFD，但它们是有前景的替代治疗方法，可提高CeD患者的生活质量并将长期后果降至最低。需要进一步研究以及对已开展的药物进行III期临床试验，以确定将这些新药纳入CeD临床管理的可行性。
