TOP-DOWN THERAPY FOR CROHN’S DISEASE : RATIONALE AND EVIDENCE
TOP-DOWN THERAPY FOR CROHN’S DISEASE : RATIONALE AND EVIDENCE
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克罗恩病的自上而下疗法：基本原理和证据
DOI：
10.1179/acb.2009.092
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发表时间：
2009
影响因子：
1.6
通讯作者：
G. D'Haens
中科院分区：
文献类型：
--
作者：
G. D'Haens
多项试验表明，早期应用免疫调节剂和抗肿瘤坏死因子药物治疗克罗恩病可获得良好的临床结果，包括粘膜愈合。越来越多的证据表明，这一终点与并发症风险的降低以及手术和住院需求的减少有关。在Sonic试验中，硫唑嘌呤和英夫利昔单抗的联合治疗是对克罗恩病患者最有效的抗炎治疗，这些患者有活动性炎症的证据，这些患者从未接触过免疫调节剂或生物制剂。这些发现导致了一种更早开始免疫调节剂治疗的趋势，与目前正在进行的类风湿性关节炎治疗相当。然而，鉴于部分患者在没有免疫调节剂治疗的情况下有良好的病程，并且考虑到这些药物的显著潜在毒性，尝试识别疾病预后不良的患者并及早积极治疗正成为胃肠病医生面临的挑战。克隆氏病的成功治疗的关键似乎在于仔细的时机选择和适当的干预措施。
Abstract Several trials have shown that early treatment of Crohn’s disease with immunomodulators and anti-TNF agents leads to superior clinical outcome including healing of the mucosa. Evidence is mounting that this endpoint is associated with a reduced risk of complications and a reduced need for surgeries and hospitalizations. In the SONIC trial, treatment with the combination of azathioprine and infliximab was the most potent anti-inflammatory therapy in Crohn’s disease patients with evidence of active inflammation who had never been exposed to immunomodulators or biologics. These findings have introduced a trend towards earlier initiation of immunomodulator therapy, comparable to what is being done in rheumatoid arthritis. Given the fact that subsets of patients have a favorable disease course without immunomodulator therapy and given the significant potential toxicity of these medications, however, it is becoming a challenge to the gastroenterologists to try and identify patients with an unfavorable disease prognosis and treat these early and aggressively. The key to successful management of Crohn’s disease appears to lie in careful timing and selection of the appropriate interventions.
影响因子：
158.5
作者：
Sands, BE;Anderson, FH;van Deventer, SJ
通讯作者：
van Deventer, SJ