Welcome to visit Zhongnan Medical Journal Press Series journal website!

Strategies and methods of medical therapy for refractory Crohn's disease

Published on Oct. 25, 2022Total Views: 2676 timesTotal Downloads: 1231 timesDownloadMobile

Author: Qiao ZHONG A-Kang SHAO Min CHEN

Affiliation: Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

Keywords: Refractory Crohn’s disease Inflammatory bowel disease Biological agent Immuno-suppressant

DOI: 10.12173/j.issn.1004-5511.202208054

Reference: Zhong Q, Shao AK, Chen M. Strategies and methods of medical therapy for refractory Crohn's disease[J]. Yixue Xinzhi Zazhi, 2022, 32(5): 388-392. DOI: 10.12173/j.issn.1004-5511.202208054.[Article in Chinese]

  • Abstract
  • Full-text
  • References
Abstract

Crohn's disease (CD) is an inflammatory bowel disease that can affect the entire digestive tract. Although new drugs have been introduced in recent years, there are still some patients who are unresponsive to various treatments. In this paper, we discuss the medical therapy strategies for refrac-tory Crohn's disease to provide a reference to assist in clinical decision-making. 

Full-text
Please download the PDF version to read the full text: download
References

1.Chang JT. Pathophysiology of inflammatory bowel diseases[J]. N Engl J Med, 2020, 383(27): 2652-2664. DOI: 10.1056/NEJMra2002697.

2.Stone JK, Shafer LA, Graff LA, et al. Utility of the MARS-5 in assessing medication adherence in IBD[J]. Inflamm Bowel Dis, 2021, 27(3): 317-324. DOI: 10.1093/ibd/izaa056.

3.Yao JY, Zhang M, Wang W, et al. Ustekinumab trough concentration affects clinical and endoscopic outcomes in patients with refractory Crohn's disease: a Chinese real-world study[J]. BMC Gastroen-terol, 2021, 21(1): 380.DOI: 10.1186/s12876-021-01946-8.

4.Fumery M, Peyrin-Biroulet L, Nancey S, et al. Effectiveness and safety of ustekinumab intensification at 90 mg every four weeks in Crohn's disease: a multicenter study[J]. J Crohns Colitis, 2020, 15(2): 222-227. DOI: 10.1093/ecco-jcc/jjaa177.

5.Hanžel J, Koželj M, Špes Hlastec A, et al. Ustekinumab concentrations shortly after escalation to monthly dosing may identify endoscopic remission in refractory Crohn's disease[J]. Eur J Gastroenterol Hepatol, 2021, 33(1S Suppl 1): e831-e836. DOI: 10.1097/MEG.0000000000002275.

6.Sedano R, Guizzetti L, McDonald C, et al. Intravenous ustekinumab reinduction is effective in prior bi-ologic failure Crohn's disease patients already on every-4-week dosing[J]. Clin Gastroenterol Hepatol, 2021, 19(7): 1497-1498. DOI: 10.1016/j.cgh.2020.07.064.

7.Peyrin-Biroulet L, Danese S, Argollo M, et al. Loss of response to vedolizumab and ability of dose in-tensification to restore response in patients with Crohn's disease or ulcerative colitis: a systematic re-view and meta-analysis[J]. Clin Gastroenterol Hepatol, 2019, 17(5): 838-846. DOI: 10.1016/j.cgh.2018.06.026.

8.Drobne D, Kurent T, Golob S, et al. Success and safety of high infliximab trough levels in inflammatory bowel disease[J]. Scand J Gastroenterol, 2018, 53(8): 940-946.DOI: 10.1080/00365521.2018.1486882.

9.Singh S, Proctor D, Scott FI, et al. AGA technical review on the medical management of moderate to severe luminal and perianal fistulizing Crohn's disease[J]. Gastroenterology, 2021, 160(7): 2512-2556. DOI: 10.1053/j.gastro.2021.04.023.

10.Hirten RP, Iacucci M, Shah S, et al. Combining biologics in inflammatory bowel disease and other im-mune mediated inflammatory disorders[J]. Clin Gastroenterol Hepatol, 2018, 16(9): 1374-1384. DOI: 10.1016/j.cgh.2018.02.024.

11.Ruffolo C, Scarpa M, Bassi N. Infliximab, azathioprine, or combination therapy for Crohn's disease[J]. N Engl J Med, 2010, 363(11): 1086-1087. DOI: 10.1056/NEJMc 1005805.

12.Mas EB, Calvo XC. Selecting the best combined biological therapy for refractory inflammatory bowel disease patients[J]. J Clin Med, 2022, 11(4): 1076. DOI: 10.3390/jcm11041076.

13.Gold SL, Steinlauf AF. Efficacy and safety of dual biologic therapy in patients with inflammatory bowel disease: a review of the literature[J]. Gastroenterol Hepatol (N Y), 2021,17(9): 406-414. https://pubmed.ncbi.nlm.nih.gov/34602905/.

14.Ahmed W, Galati J, Kumar A, et al. Dual biologic or small molecule therapy for treatment of inflam-matory bowel disease: a systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol, 2022, 20(3): e361-e379. DOI: 10.1016/j.cgh.2021.03.034.

15.Glassner K, Oglat A, Duran A, et al. The use of combination biological or small molecule therapy in inflammatory bowel disease: a retrospective cohort study[J]. J Dig Dis, 2020, 21(5): 264-271. DOI: 10.1111/1751-2980.12867.

16.Privitera G, Onali S, Pugliese D, et al. Dual targeted therapy: a possible option for the management of refractory inflammatory bowel disease[J]. J Crohns Colitis, 2020, 15(2): 335-339. DOI: 10.1093/ecco-jcc/jjaa149.

17.Dulai PS, Boland BS, Singh S, et al. Development and validation of a scoring system to predict out-comes of vedolizumab treatment in patients with Crohn's disease[J]. Gastroenterology, 2018, 155(3): 687-695. DOI: 10.1053/j.gastro.2018.05.039.

18.Alric H, Amiot A, Kirchgesner J, et al. The effectiveness of either ustekinumab or vedolizumab in 239 patients with Crohn's disease refractory to anti-tumour necrosis factor[J]. Aliment Pharmacol Ther, 2020, 51(10): 948-957. DOI: 10.1111/apt.15706.

19.Biemans V, van der Woude CJ, Dijkstra G, et al. Ustekinumab is associated with superior effectiveness outcomes compared to vedolizumab in Crohn's disease patients with prior failure to anti-TNF treat-ment[J]. Aliment Pharmacol Ther, 2020, 52(1): 123-134. DOI: 10.1111/apt.15745.

20.Lazzerini M, Martelossi S, Magazzu G, et al. Effect of thalidomide on clinical remission in children and adolescents with refractory Crohn disease: a randomized clinical trial[J]. JAMA, 2013, 310(20): 2164-2173. DOI: 10.1001/jama.2013.280777.

21.徐舒, 祖晓满, 冯瑞, 等. 沙利度胺治疗难治性克罗恩病的长期疗效及安全性分析[J]. 中华内科杂志, 2020, 59(6): 445-450. [Xu S, Zu XM, Feng R, et.al. Thalidomide in refractory Crohn's disease: long-term efficacy and safety[J]. Chinese Journal of Internal Medicine, 2020, 59(6): 445-450.] DOI: 10.3760/cma.j.cn112138-2019 1206-00800.

22.Thin LW, Murray K, Lawrance IC. Oral tacrolimus for the treatment of refractory inflammatory bowel disease in the biologic era[J]. Inflamm Bowel Dis, 2013, 19(7): 1490-1498. DOI: 10.1097/MIB.0b013e318281f362.

23.徐锡涛, 吴碧玉, 戴张晗, 等. 他克莫司治疗难治性克罗恩病的短期疗效分析[J]. 中华炎性肠病杂志, 2022, 6(2): 115-121. [Xu XT, Wu BY, Dai ZH, et al. Analysis of the short-term efficacy of tacrolimus in the treat-ment of refractory Crohn's disease[J]. Chinese Journal of Inflammatory Bowel Diseases, 2022, 6(2): 115-121.] DOI: 10.3760/cma.j.cn101480-20220302-00033.

24.Mesonero F, Castro-Poceiro J, Benitez JM, et al. Effectiveness and safety of methotrexate monother-apy in patients with Crohn's disease refractory to anti-TNF-alpha: results from the ENEIDA registry[J]. Aliment Pharmacol Ther, 2021, 53(9): 1021-1029. DOI: 10.1111/apt.16315.

25.徐萍萍, 何瑶, 陈瑜君, 等. 甲氨蝶呤治疗难治性克罗恩病的疗效及安全性分析[J]. 中华内科杂志, 2014, 53(3): 188-192. [Xu PP, He Y, Chen YJ, et.al. The efficacy and safety of methotrexate in refractory Crohn's disease[J]. Chinese Journal of Internal Medicine, 2014, 53(3): 188-192.] DOI: 10.3760/cma.j.issn.0578-1426.2014.03.008.

26.Narula N, Dhillon A, Zhang D, et al. Enteral nutritional therapy for induction of remission in Crohn's disease[J]. Cochrane Database Syst Rev, 2018, 4(4): CD000542. DOI: 10.1002/14651858.CD000542.pub3.

27.Zhang HM, Yuan S, Meng H, et al. Stem cell-based therapies for inflammatory bowel disease[J]. Int J Mol Sci, 2022, 23(15): 8494. DOI: 10.3390/ijms23158494.

28.Hawkey CJ, Allez M, Clark MM, et al. Autologous hematopoetic stem cell transplantation for refracto-ry crohn disease: a randomized clinical trial[J]. JAMA, 2015, 314(23): 2524-2534. DOI: 10.1001/jama.2015.16700.

29.Qiu X, Feng JR, Chen LP, et al. Efficacy and safety of autologous hematopoietic stem cell therapy for refractory  Crohn's disease: a systematic review and meta-analysis[J]. Medicine (Baltimore), 2017, 96(26): e7381. DOI: 10.1097/MD.0000000000007381.