Maneuvering Clinical Pathways for Crohn's Disease.
Maneuvering Clinical Pathways for Crohn's Disease.
复制标题
克罗恩病的临床治疗路径。
DOI：
10.1007/s11894-019-0687-4
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发表时间：
2019
影响因子：
--
通讯作者：
Cohen,RussellD
中科院分区：
文献类型：
--
作者：
Lu,ThomasX;Cohen,RussellD
Purpose of ReviewCrohn’s disease management has changed significantly with increasing use of biologics. We review the recent literature on the clinical management of Crohn’s disease and new approaches in selecting and optimizing therapy.Recent FindingsRecent studies have addressed the efficacy of proactive anti-TNFα trough level monitoring, the efficacy of biosimilars, and the efficacy and immunogenicity of newer biologics including anti-integrin therapy and anti-IL12/23 therapy. Optimizing anti-TNFα therapy according to trough concentrations correlates with improved remission rates. Patients can be switched from the reference drug to a biosimilar, or vice versa, without a measurable change in efficacy, safety, or immunogenicity. Immunomodulators are effective in decreasing immunogenicity and boosting anti-TNFα drug level. The anti-integrin and anti-IL12/23 therapies are effective as induction and maintenance therapy with low immunogenicity and excellent safety profiles. Patients at high risk for post-operative recurrence should be started on a biologic therapy within 4 weeks post-op.SummaryMultiple biologic therapies are currently available for treatment of Crohn’s disease including anti-TNFα therapy, anti-integrin therapy, and anti-IL12/23 therapy. The choice of first-line therapy should be based on individual risk-benefit analysis, route of administration, and patient preference. Patient with inadequate response should have their trough level checked and therapy optimized. Therapeutic prophylaxis for post-operative recurrence should be based on patient’s risk factors for recurrence.
