期刊
EXPERT REVIEW OF CLINICAL IMMUNOLOGY
卷 13, 期 10, 页码 963-973出版社
TAYLOR & FRANCIS LTD
DOI: 10.1080/1744666X.2017.1343668
关键词
Cytokines; inflammatory bowel disease; interleukin-12; interleukin-23; Janus kinase inhibitor; SMAD7; sphingosine-1-phosphate phosphatase modulator; therapy; tumor necrosis factor inhibitors; ulcerative colitis; vedolizumab
类别
资金
- Helmsley Charitable Trust
- Ministerio de Economia y Competitividad, Spain [SAF2015-66379-R]
Introduction: Therapeutic strategies in ulcerative colitis are evolving. A personalized and optimal use of available drugs and the integration of new drug classes are the cornerstones underpinning the new treatment paradigms. Areas covered: A structured literature search in Medline and PubMed, Cochrane meta-analyses, and abstracts of international congresses has been performed to review therapeutic approaches to ulcerative colitis. The primary therapeutic objective of therapy is to achieve clinical remission since persistence of active disease, even if mild, leads to a significant reduction in quality of life. Current treatment paradigms of ulcerative colitis are based on the use of 5-aminosalycilates, corticosteroids, thiopurines, TNF-alpha inhibitors and alpha 4 beta 7 integrin blockers. The main determinants for drug class selection are disease extension, disease severity, and previous drug history. New drug classes that will likely become available in the foreseeable future include inhibitors of Janus kinases, modulators of sphingosine-1phosphate receptors, SMAD-7 antisense oligonucleotides, interleukin-12/23 blockers, and fecal microbiota transplantation. Expert commentary: Increasing therapeutic options for ulcerative colitis make predictors of response highly relevant. While these are not available, judicious use of therapies, avoidance of underdosing, or persistent therapy when criteria for drug failure are met are essential.
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