IBD常用的免疫抑制剂ppt参考课件.ppt

* * Key Point: Traditional “bottom-up” therapy as recommended by the American College of Gastroenterology (ACG) in its UC practice guidelines utilizes conventional medications such as 5-aminosalicylates (5-ASAs) as first-line therapies, while reserving more aggressive agents (eg, infliximab, IV steroids, cyclosporine) for more severe and/or refractory patients. Background: Current therapeutic paradigms recommend 5-ASA agents as first-line therapy for patients with mild to moderate UC.1 Oral corticosteroids are typically reserved for patients who do not respond to oral 5-ASA agents with or without topical agents, or for patients who need rapid improvement.1 Infliximab has demonstrated efficacy in patients who have moderate to severe UC despite receiving therapy with conventional agents.2 Aggressive medical therapies (IV corticosteroids, cyclosporine) are generally reserved for patients with severe or fulminant UC not responding to maximal oral doses of 5-ASAs and corticosteroids.1 References1. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2004;99(7):1371-1385. 2. Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353:2462-2476. * * Key Point: Although preliminary data in Crohn’s disease suggest that reversing the traditional “step-up” treatment pyramid in favor of “top-down” therapy in newly diagnosed patients may result in early disease stabilization and disease modification, this approach has not been well studied in UC. Background: ? The use of a “top-down” approach in UC has not been studied prospectively to date. Preliminary, 2-year, open-label data in Crohn’s disease have demonstrated that initiating aggressive medical therapy (ie, infliximab) early in the course of disease may result in better outcomes such as improved mucosal healing and redu