炎症性肠病中免疫调节剂和生物制剂的降级治疗  

De-escalation of Immunomodulators and Biological Agents in Inflammatory Bowel Disease

作　　者：施嫣红[1] 刘占举[1] SHI Yanhong;LIU Zhanju(Department of Gastroenterology,the Tenth People’s Hospital of Tongji University,Shanghai,200072)

机构地区：[1]同济大学附属第十人民医院消化内科,200072

出　　处：《胃肠病学》2021年第1期1-8,共8页Chinese Journal of Gastroenterology

基　　金：上海市卫生计生委资助项目(201640159)。

摘　　要：免疫调节剂和生物制剂在炎症性肠病(IBD)的治疗中广泛应用,可有效诱导疾病缓解,但这些药物与严重不良事件相关,且长期使用导致治疗费用不断增加。因此,IBD患者一旦病情缓解,即需考虑药物降级治疗的安全性和可行性,此时须权衡持续用药的风险与疾病复发的风险。本文对已发表的关于克罗恩病和溃疡性结肠炎免疫调节剂和生物制剂降级治疗的文献进行评估,明确了停药后IBD复发的危险因素,如疾病活动性、疾病预后特征和既往病程因素,并讨论降级治疗策略和积极的药物监测,以期为临床实践提供一定指导。Immunomodulators and biological agents are widely used in inflammatory bowel disease(IBD),and induce remission effectively.However,these drugs are related to serious adverse events,and coupled with increasing treatment costs.Therefore,once patients with IBD are in remission,the safety and feasibility of drug de-escalation should be considered,and the risk of continuing medical therapy against the risk of disease relapse must be weighed.This review article analyzed the published literatures on de-escalation of immunomodulators and biological agents in patients with Crohn’s disease and ulcerative colitis,identifying the risk factors of relapse after drug withdrawal,such as disease activity,prognostic features and previous disease course,and discussed the strategies for de-escalation and use of proactive therapeutic drug monitoring,so as to provide some guidance for clinical practice.

关 键 词：CROHN病 结肠炎 溃疡性 免疫调节剂 生物制剂 降级治疗 

分 类 号：R574[医药卫生—消化系统]