Treatment algorithms in Crohn's - Up, down or something else?
Treatment algorithms in Crohn's - Up, down or something else?
复制标题
DOI：
10.1016/j.bpg.2014.05.001
复制
发表时间：
2014-06-01
影响因子：
3.2
通讯作者：
Peyrin-Biroulet, Laurent
中科院分区：
文献类型：
--
作者：
Antunes, Ophelie;Filippi, Jerome;Peyrin-Biroulet, Laurent
克罗恩病是一种慢性、进行性和致残性疾病。克罗恩病出现了新的治疗目标，例如需要通过实现粘膜愈合来超越症状，这被认为与更好的结果相关。抗肿瘤坏死因子治疗是诱导和维持克罗恩病粘膜愈合的最有效的药物类别。最近的证据表明，硫嘌呤的疗效被高估了，而患恶性肿瘤(淋巴瘤、非黑色素瘤皮肤癌、髓系疾病)的风险却被低估了。甲氨蝶呤耐受性良好，但其用于疾病修改的潜力尚不清楚。早期克罗恩病患者实现粘膜愈合可能是改变病程和患者生活的最好方法。2014年，对于患有严重和/或复杂疾病的克罗恩病患者以及预后因素较差的患者，抗肿瘤坏死因子治疗应成为一线治疗。对于其余的患者，建议在严密监测的基础上采取快速渐进的方法。(C)2014爱思唯尔有限公司。保留所有权利。
Crohn's disease is a chronic, progressive and disabling condition. New therapeutic goals have emerged in Crohn's disease such as the need to look beyond symptoms by achieving mucosal healing that is known to be associated with better outcomes. Anti-TNF (Tumour Necrosis Factor) therapy is the most potent drug class to induce and maintain mucosal healing in Crohn's disease. Recent evidence indicates that the efficacy profile of thiopurines has been overestimated while the increased risk of malignancies (lymphoma, non-melanoma skin cancers, myeloid disorders) has been underestimated. Methotrexate is well-tolerated, but its potential for disease modification is unknown. Achieving mucosal healing in patients with early Crohn's disease might be the best way to change disease course and patients' life. In 2014, anti-TNF treatment should be the first-line therapy in patients with Crohn's disease who suffer from severe and/or complicated disease and in those with poor prognostic factors. In the remaining patients, a rapid step-up approach based on a tight monitoring is recommended. (C) 2014 Elsevier Ltd. All rights reserved.