A Literature Review on Immunosuppressants and Biologics for Induction of Remission in Active Chron’s Disease
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Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Kopsavilkums
Ievads un mērķi:
Pacientiem ar Krona slimību bieži rodas atkārtoti recidīvi. Efektīva klīniskās remisijas sasniegšana ir svarīga, lai iegūtu simptomu kontroli. Šī literatūras pārskata mērķis ir apspriest visbiežāk sastopamo imūnsupresantu (azatioprīna, 6-merkatopurīna, metotreksāta) un bioloģisko medikamentu (infliksimaba, adalimumaba, certolizumaba pegola, ustekinumaba), ko lieto Krona slimības remisijas indukcijai efektivitāti.
Metodes:
Šajā pārskatā ir iekļauti četrpadsmit randomizēti kontrolēti pētījumi un četri sistemātiskie pārskati, kas izvērtē dažādus imūnsupresantus un bioloģiskos medikamentus. Pētījumi tika atlasīti, izmantojot literatūras meklēšanu tiešsaistē uz pierādījumiem balstītas medicīnas datu bāzēs un pārskatīti pilnībā.
Rezultāti:
Trīs randomizēti kontrolēti pētījumi un viens sistemātiskais pārskats parāda, ka azatioprīnam vai 6-merkatpurīnam monoterapijā ir neliela ietekme uz Krona slimības remisijas indukciju, salīdzinot ar placebo. Divi randomizēti kontrolēti pētījumi un viens sistemātiskais pārskats liecina, ka metotreksātam varētu būt maza ietekme uz remisijas indukciju, taču ir nepieciešami papildu pētījumi. Septiņi randomizēti kontrolēti pētījumi un divi sistemātiskie pārskati liecina, ka infliksimabs, adalimumabs un certolizumabs pegols visi efektīvi izraisa klīnisko remisiju. Ir pierādīts, ka kombinācija ar infliksimabu un azatioprīnu vai adalimumaba monoterapija ir visefektīvākā klīniskās remisijas izraisīšanā lielākajai daļai pacientu ar aktīvu Krona slimību. Divi randomizēti kontrolēti pētījumi un viens sistemātiskais pārskats liecina, ka ustekinumabs ir efektīvs, lai izraisītu klīnisko remisiju pacientiem, kuriem terapija ar tumora nekrozes faktora α preparātiem ir neefektīva vai kuriem nevar pielietot ierastās terapijas blakusparādību dēļ.
Secinājumi:
Infliksimabs kombinācijā ar azatioprīnu vai adalimumaba monoterapija, iespējams, ir visefektīvākā terapija klīniskās remisijas indukcijai lielākajai daļai pacientu ar aktīvu Krona slimību.
Abstract Background & aims: Patients with Crohn’s disease often experience recurrent relapses. Inducing clinical remission in an efficient way is important to obtain control over symptoms. This literature review aims to discuss the efficiency of the most common immunosuppressants (azathioprine, 6-mercaptopurine, methotrexate) and biologics (infliximab, adalimumab, certolizumab pegol, ustekinumab) used for induction of remission in Chron’s disease. Method: Fourteen randomised controlled trials and four systematic reviews assessing different immunosuppressants and biologics are included in this review. The studies were obtained through a literature search in online evidence based medical databases and reviewed in full. Results: Three randomised controlled trials and one systematic review shows that azathioprine or 6-mercaptopurine as monotherapy has a minor effect on the induction of remission when compared to a placebo. Two randomised controlled trials and one systematic review show that methotrexate might have small effect on the induction of remission, but further research is needed. Seven randomised controlled trials and two systematic reviews show a that infliximab, adalimumab and certolizumab pegol are all efficient in inducing clinical remission. The combination with infliximab and azathioprine or adalimumab monotherapy is possibly the most efficient in inducing clinical remission in most patients with active Crohn’s disease. Two randomised controlled trials and one systematic review show that ustekinumab is efficient in inducing clinical remission in patients which has a TNF-α inhibitors non-response or cannot use TNF-α due to development of side effects. Conclusion: Infliximab in combination with azathioprine or adalimumab monotherapy is possibly the most efficient in inducing clinical remission in most patients with active Crohn’s disease of moderate – to – severe degree.
Abstract Background & aims: Patients with Crohn’s disease often experience recurrent relapses. Inducing clinical remission in an efficient way is important to obtain control over symptoms. This literature review aims to discuss the efficiency of the most common immunosuppressants (azathioprine, 6-mercaptopurine, methotrexate) and biologics (infliximab, adalimumab, certolizumab pegol, ustekinumab) used for induction of remission in Chron’s disease. Method: Fourteen randomised controlled trials and four systematic reviews assessing different immunosuppressants and biologics are included in this review. The studies were obtained through a literature search in online evidence based medical databases and reviewed in full. Results: Three randomised controlled trials and one systematic review shows that azathioprine or 6-mercaptopurine as monotherapy has a minor effect on the induction of remission when compared to a placebo. Two randomised controlled trials and one systematic review show that methotrexate might have small effect on the induction of remission, but further research is needed. Seven randomised controlled trials and two systematic reviews show a that infliximab, adalimumab and certolizumab pegol are all efficient in inducing clinical remission. The combination with infliximab and azathioprine or adalimumab monotherapy is possibly the most efficient in inducing clinical remission in most patients with active Crohn’s disease. Two randomised controlled trials and one systematic review show that ustekinumab is efficient in inducing clinical remission in patients which has a TNF-α inhibitors non-response or cannot use TNF-α due to development of side effects. Conclusion: Infliximab in combination with azathioprine or adalimumab monotherapy is possibly the most efficient in inducing clinical remission in most patients with active Crohn’s disease of moderate – to – severe degree.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
aktīvu Krona slimību, Chron's disease, induction therapy, immunosuppressants, biologics