Biological therapies in inflammatory bowel disease: top-down or bottom-up?
Biological therapies in inflammatory bowel disease: top-down or bottom-up?
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DOI：
10.1097/mog.0b013e32815b601b
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发表时间：
2007-07-01
影响因子：
2.5
通讯作者：
Hommes, Daan
中科院分区：
文献类型：
--
作者：
Oldenburg, Bas;Hommes, Daan
综述目的传统的治疗方法不能或只能在一定程度上预防炎症性肠病的手术或并发症。早期积极或“自上而下”治疗的新概念是从新生物制剂治疗标准治疗难治性患者的令人印象深刻的结果中发展而来的。新的数据，表明这一战略可能是有利的，最近已published.Recent findingsIn非对照研究，早期管理的硫唑嘌呤以及英夫利昔单抗已被证明是与缓解克罗恩病患者的长期维持。最近公布的一项对照研究的初步数据比较了英夫利西单抗和硫唑嘌呤的早期给药（“自上而下”治疗）与传统的“逐步增加”治疗，结果显示上级粘膜愈合更好，缓解更快，缓解率更高。率不耐烦的自上而下的治疗armb.The正在进行的SONIC研究，比较英夫利西单抗治疗与硫唑嘌呤，将提供更多的信息，这两种药物在这方面的相对重要性。目前还不能提倡这种方法的标准使用。
Purpose of reviewConventional therapeutic algorithms cannot, or only to a certain degree, prevent surgery or complications in inflammatory bowel disease. The new concept of early aggressive or 'top-down' treatment has evolved from the impressive results of new biological agents in the treatment of patients who were refractory to standard therapy. New data, suggesting that this strategy may be advantageous, has recently been published.Recent findingsIn uncontrolled studies, early administration of azathioprine as well as infliximab has been shown to be associated with a prolonged maintenance of remission in Crohn's disease patients. The recently presented preliminary data from a controlled study comparing early administration of infliximab and azathioprine ('top-down' therapy) versus conventional 'step-up' therapy showed superior mucosal healing, a more rapid remission and higher remission. rates impatient's in the top-down treatment arm. The ongoing SONIC study, which compares infliximab therapy with and without azathioprine, will provide additional information regarding the relative importance of both drugs in this respect.SummaryThe significance of top-down treatment remains to be confirmed in prospective clinical studies aimed at high-risk patients. The standard use of this approach cannot be advocated presently.