RESUMO
The treatment of inflammatory bowel disease has undergone a significant transformation following the introduction of biologic drugs. Thanks to these drugs, treatment goals have evolved from clinical response and remission to more ambitious objectives, such as endoscopic or radiologic remission. However, even though biologics are highly effective, a significant percentage of patients will not achieve an initial response or may lose it over time. We know that there is a direct relationship between the trough concentrations of the biologic and its therapeutic efficacy, with more demanding therapeutic goals requiring higher drug levels, and inadequate exposure being common. Therapeutic drug monitoring of biologic medications, along with pharmacokinetic models, provides us with the possibility of offering a personalized approach to treatment for patients with IBD. Over the past few years, relevant information has accumulated regarding its utility during or after induction, as well as in the maintenance of biologic treatment, in reactive or proactive strategies, and prior to withdrawal or treatment de-escalation. The aim of this document is to establish recommendations regarding the utility of therapeutic drug monitoring of biologics in patients with inflammatory bowel disease, in different clinical practice scenarios, and to identify areas where its utility is evident, promising, or controversial.
Assuntos
Produtos Biológicos , Colite Ulcerativa , Doença de Crohn , Monitoramento de Medicamentos , Humanos , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Produtos Biológicos/farmacocinética , Doenças Inflamatórias Intestinais/tratamento farmacológicoRESUMO
Surgery in Crohn's disease may be the cause of short bowel syndrome that may lead to kidney dysfunction. Dual biologic therapy is rarely needed to control activity. We present a case of a 61-year-old steroid dependent (A2L1B3p) female who had undergone surgery on three occasions: ileocecal resection (resection of 15 cm of terminal ileum); resection of right and left colon up to sigmoid; proctectomy with intersphincteric resection along with ileostomy due to a rectovaginal fistula. She had been previously treated with prednisone, azathioprine, methotrexate, infliximab and adalimumab but the treatment was discontinued owing to adverse effects. Vedolizumab was started, showing good control of the luminal activity but the rectovaginal fistula recurred. Treatment changed to ustekinumab, the fistula activity was controlled but the mucosa activity recurred. 11 months after commencing with ustekinumab, vedolizumab was added to the treatment and complete remission was achieved for three years. Simultaneously, the patient developed renal dysfunction derived from the short bowel syndrome that led to chronic kidney failure. In the face of potential renal replacement therapy, a new therapy with 2.5 mg/sc/d teduglutide was started achieving stable figures of creatinine and normalization of the glomerular filtration rate.
Assuntos
Doença de Crohn , Síndrome do Intestino Curto , Feminino , Humanos , Pessoa de Meia-Idade , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Doença de Crohn/induzido quimicamente , Ustekinumab/efeitos adversos , Síndrome do Intestino Curto/tratamento farmacológico , Fístula Retovaginal , Terapia Biológica , Resultado do TratamentoRESUMO
There are aspects of Janus kinase (JAK) inhibitors, specifically tofacitinib, that distinguish them from other drugs used in the treatment of ulcerative colitis (UC), such as their oral administration, their short half-life and their lack of immunogenicity. With the available evidence, we can highlight tofacitinib's quick action and flexibility of use, and its efficacy in patients, irrespective of whether or not they have previously been exposed to TNF inhibitors (anti-TNF drugs) and other biologic agents. Moreover, their safety profile is known and manageable, with certain considerations and precautions being factored in before and during treatment. In this review, we have defined various scenarios pertaining to this drug, e.g. its use in the event of failure or intolerance to previous treatment with biologics, when a quick response is required or in patients with other concurrent immune-mediated diseases.
RESUMO
We have read with interest the article published by Pérez et al., we really appreciate their interesting comments and would like to qualify some points. With the except of the clinical practice, currently there is no recommendation based on scientific evidence about the use of apheresis in the treatment of ulcerative colitis (UC), and even less in Crohn's disease (CD). However, the results obtained in the case of Pérez et al. in relation to systemic inflammation and pulmonary clinical improvement are very interesting from a pathophysiological and clinical point of view.
Assuntos
Colite Ulcerativa , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Betacoronavirus , COVID-19 , Infecções por Coronavirus , Sistema Digestório , Humanos , Pandemias , Pneumonia Viral , SARS-CoV-2RESUMO
The purpose of this rapid review is to provide an update on the impact of SARS-CoV-2 infection on Gastroenterology and Hepatology departments, our patients, and our new way of working. The gastrointestinal tract and the liver are affected by SARS-CoV-2, especially in patients with immunosuppressive therapies. Patients with liver transplantation should be followed closely. Digestive endoscopy is a high-risk procedure for the transmission of SARS-CoV-2. While the pandemic lasts, we must adapt its indications and promote protective measures for patients and healthcare professionals alike. The COVID-19 pandemic has changed our priorities and the way we work, although we do not know what the repercussions will be after normality is reinstated.
Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/transmissão , Doenças do Sistema Digestório/virologia , Sistema Digestório/virologia , Pandemias , Pneumonia Viral/transmissão , COVID-19 , Infecções por Coronavirus/virologia , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/terapia , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia do Sistema Digestório/efeitos adversos , Humanos , Imunossupressores/efeitos adversos , Controle de Infecções/métodos , Transplante de Fígado , Pneumonia Viral/virologia , SARS-CoV-2RESUMO
Vedolizumab is an anti-integrin monoclonal antibody indicated for the treatment of patients with moderately to severely active Crohn's disease and ulcerative colitis who have failed conventional or anti-TNF therapies. The objective of this article is to answer a series of very practical questions regarding the management of both diseases with vedolizumab, based on data from published literature, as well as on the experience acquired by the authors in clinical practice in recent years.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Humanos , Guias de Prática Clínica como Assunto , Resultado do TratamentoRESUMO
In 2013, the European Medicines Agency (EMA) approved the biosimilar infliximab (CT-P13) for the full range of indications of the originator product, based on data from two trials conducted in rheumatoid arthritis and ankylosing spondylitis. The same year, our Society published a position statement that was later reviewed.
Assuntos
Anti-Inflamatórios/uso terapêutico , Medicamentos Biossimilares/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab/uso terapêutico , Humanos , Guias de Prática Clínica como AssuntoAssuntos
Adalimumab/efeitos adversos , Corticosteroides/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Doença de Crohn/tratamento farmacológico , Imunossupressores/efeitos adversos , Infecções Oportunistas/etiologia , Aspergilose Pulmonar/etiologia , Adalimumab/uso terapêutico , Corticosteroides/uso terapêutico , Adulto , Anti-Inflamatórios/uso terapêutico , Antifúngicos/uso terapêutico , Cilastatina/uso terapêutico , Doença de Crohn/complicações , Diagnóstico Diferencial , Suscetibilidade a Doenças , Humanos , Imipenem/uso terapêutico , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnósticoAssuntos
Doença de Crohn/complicações , Enteropatias Parasitárias/complicações , Miíase/complicações , Adulto , Animais , Doença de Crohn/tratamento farmacológico , Doença de Crohn/parasitologia , Dípteros/crescimento & desenvolvimento , Suscetibilidade a Doenças , Fezes/parasitologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Enteropatias Parasitárias/parasitologia , Larva , Miíase/parasitologiaRESUMO
The Spanish Society of Rheumatology (SER), through a multidiscipline task force, has elaborated a document with specific recommendations for specialists in Rheumatology, emphasizing the special needs of patients with rheumatic diseases, with the objective of informing and orienting health professionals about the current influenza A/H1N1 virus pandemic. All of the recommendations are based on prior documents elaborated by the Ministry of Health and Social Policy task forces, as well as those from the autonomous communities, which are themselves based on the guidelines and documents routinely published by the Centers for Disease Control (CDC) in the US, this being the center designated by WHO for the coordination of efforts against the pandemic. All rheumatologists and potential users of these recommendations are encouraged to consult the original documents, as well as the general guidelines established at each health center.