Loading...
Publication
Eficácia e efetividade da terapêutica biológica na doença de Crohn em doentes bio-naïve e não-naïve
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 3.66 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Introdução: A Doença de Crohn (DC) tem capacidade de afetar qualquer parte do trato gastrointestinal, e a sua etiopatogenia depende de vários fatores. O tratamento tem como objetivo a indução e manutenção da remissão clínica, cicatrização da mucosa e melhoria da qualidade de vida, e tem evoluído com a utilização de tratamentos biológicos.
Objetivo: Este trabalho tem como objetivo responder à pergunta: Existe diferença na eficácia e efetividade da terapêutica biológica em doentes bio naïve e não-naïve com DC?
Materais e Métodos: Foi efetuada uma pesquisa de estudos pulicados nos últimos 10 anos utilizando a base de dados PubMed e os MeSH terms: (Crohn's disease) AND ((first-line) AND (second-line))) AND (biologic treatment).
Resultados: A escolha da terapêutica biológica depende de múltiplos fatores, nomeadamente, idade, antecedentes e comorbilidades, fatores associados à doença (extensão e expressão fenotípica da doença) e custo associado à terapêutica.
O tratamento com anti-TNFa, infliximab ou adalimumab, é o mais eficaz e efetivo para indução e manutenção da remissão clínica da DC moderada a grave em doentes naïve, sendo que uma combinação de infliximab e azatioprina tem uma eficácia superior ao infliximab em monoterapia. A terapia com azatioprina não foi validada para outros biológicos.
O bloqueio da IL-23 mostrou ser o mecanismo de ação mais eficaz e efetivo em doentes experimentados.
Conclusões: Os resultados de que dispomos para decisão clínica de escolha dos fármacos biológicos tem como base a comparação indireta em meta-análises e estudos de vida real, que mostram maior efetividade em doentes naïve.
Estão a decorrer estudos prospetivos de comparação direta entre fármacos e também estudos de novas moléculas sintéticas e biológicos (antagonistas da JAK, integrinas, anti-IL- 23 e moduladores do recetor da esfingosina-1-fosfato), cujos resultados se aguardam e, irão expandir e otimizar as decisões terapêuticas nos doentes com esta patologia.
Introduction: Crohn's Disease (CD) can affect any part of the gastrointestinal tract and it’s etiopathogenesis depends on several factors. The treatment aims to induce and maintain clinical remission, mucosal healing, improve quality of life, and has evolved with the use of biological treatments. Objective: This work aims to answer the question: Is there a difference in the efficacy and effectiveness of biological therapy in bio-naïve and non-naïve CD patients? Materials and Methods: A search for published studies in the last 10 years was performed using PubMed database and MeSH terms: (Crohn's disease) AND ((first-line) AND (secondline))) AND (biologic treatment). Results: The choice of therapy depends on multiple factors, namely, age, history and comorbidities, factors related to the disease (extent and phenotypic expression of the disease) and associated cost. Treatment with anti-TNFα, infliximab or adalimumab, is the most effective for inducing and maintaining clinical remission of moderate to severe CD in naïve patients, with a combination of infliximab and azathioprine being more effective than infliximab alone. Combination therapy with azathioprine has not been validated for other biologics. Blockade of IL23 was shown to be the most effective mechanism of action in experienced patients. Conclusions: The data we have for clinical decision on the choice of biological drugs are based on indirect comparison in meta-analyses and real-life studies, which show greater effectiveness in naïve patients. Prospective studies of direct comparison between drugs are ongoing, as well as studies of new synthetic and biological molecules (JAK, integrins and IL-23 antagonists, and sphingosine-1-phosphate receptor modulators), whose results are expected and will expand and optimize therapeutic decisions in patients with this pathology.
Introduction: Crohn's Disease (CD) can affect any part of the gastrointestinal tract and it’s etiopathogenesis depends on several factors. The treatment aims to induce and maintain clinical remission, mucosal healing, improve quality of life, and has evolved with the use of biological treatments. Objective: This work aims to answer the question: Is there a difference in the efficacy and effectiveness of biological therapy in bio-naïve and non-naïve CD patients? Materials and Methods: A search for published studies in the last 10 years was performed using PubMed database and MeSH terms: (Crohn's disease) AND ((first-line) AND (secondline))) AND (biologic treatment). Results: The choice of therapy depends on multiple factors, namely, age, history and comorbidities, factors related to the disease (extent and phenotypic expression of the disease) and associated cost. Treatment with anti-TNFα, infliximab or adalimumab, is the most effective for inducing and maintaining clinical remission of moderate to severe CD in naïve patients, with a combination of infliximab and azathioprine being more effective than infliximab alone. Combination therapy with azathioprine has not been validated for other biologics. Blockade of IL23 was shown to be the most effective mechanism of action in experienced patients. Conclusions: The data we have for clinical decision on the choice of biological drugs are based on indirect comparison in meta-analyses and real-life studies, which show greater effectiveness in naïve patients. Prospective studies of direct comparison between drugs are ongoing, as well as studies of new synthetic and biological molecules (JAK, integrins and IL-23 antagonists, and sphingosine-1-phosphate receptor modulators), whose results are expected and will expand and optimize therapeutic decisions in patients with this pathology.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Doença de Crohn Terapêutica biológica Eficácia Naïve