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Abstract(s)
Nos últimos anos tem-se assistido a um aumento do número de casos
diagnosticados de Doença Inflamatória Intestinal (DII), aumento este que tem
sido acompanhado por grandes progressos a nível da investigação da sua
fisiopatologia e pelo constante aparecimento de novos fármacos, que têm
revolucionado a terapêutica desta doença.
O objectivo deste trabalho é fazer uma revisão bibliográfica das novas
terapêuticas da DII, incidindo sobretudo na sua eficácia e segurança. São
abordados os agentes biológicos já aprovados, assim como agentes ainda
experimentais, deixando novas perspectivas para o futuro. É ainda feita uma
breve revisão da abordagem terapêutica clássica – step up - para depois a
comparar com a nova abordagem, mais agressiva e individualizada, baseada
nos agentes biológicos – top down.
Os materiais métodos utilizados consistiram em livros e revistas da
especialidade, bem como a pesquisa de artigos no PubMed.
Esta doença desenvolve-se em indivíduos geneticamente predispostos,
nos quais um antigénio despoleta uma cascata de reacções inflamatórias, que
culminam numa resposta imune exacerbada que, por sua vez, se traduz numa
má qualidade de vida para os doentes.
As terapêuticas clássicas, baseadas nos aminossalicilatos e
corticosteróides, estão longe de responder a todas necessidades destes
doentes e, por isso, as novas terapêuticas estão a ganhar espaço. Os mais
promissores são os agentes biológicos, dirigidos a mecanismos específicos da doença. Para já, em Portugal o infliximab é o único utilizado, nos E.U.A o
certolizumab também já foi aprovado para a DII, mas muitos outros estão a ser
desenvolvidos e considerados potencialmente eficazes. O dilema da terapia
“step up” versus “top down” persiste, devendo ser analisado individualmente e
de acordo com o bom senso clínico.
In the last few years, there has been an increase in the number of diagnosed cases of Inflammatory Bowel Disease (IBD), which has been accompanied by huge progresses on the investigation of its physiopathology and by the constant appearance of new drugs, which have revolutionized the treatment of this disease. The purpose of this work is to make a bibliographic revision of the new therapeutics of IBD, focusing mainly in its efficacy and safety. The biologic agents already approved will be approached, as well as some experimental ones, leaving new perspectives for the future. The classic therapy– step up – will also be approached comparing it with the new one, more aggressive and individualized, based on the biologic agents – top down. The bibliographic resources used consisted on books and magazines of the specialty, as well as the research of articles on PubMed. This disease develops in genetically predisposed individuals, in which a antigen triggers a inflammatory cascade, that results in a exacerbated immune response which translates in a poor quality of life to the patient. The classic therapies, based on the aminossalicilates and steroids, are far from answer to all patient´s needs and, so, the new therapies are taking place. The most promising ones are the biologic agents, targeting specific disease mechanisms. So far, in Portugal Infliximab is the only one used, while in the U.S.A. Certolizumab has also been approved for IBD. Many more are being developed and have been considered potentially efficacious. The dilemma “step up” versus “top down” therapy persists, and should be analyzed individually and according to the clinic’s good sense.
In the last few years, there has been an increase in the number of diagnosed cases of Inflammatory Bowel Disease (IBD), which has been accompanied by huge progresses on the investigation of its physiopathology and by the constant appearance of new drugs, which have revolutionized the treatment of this disease. The purpose of this work is to make a bibliographic revision of the new therapeutics of IBD, focusing mainly in its efficacy and safety. The biologic agents already approved will be approached, as well as some experimental ones, leaving new perspectives for the future. The classic therapy– step up – will also be approached comparing it with the new one, more aggressive and individualized, based on the biologic agents – top down. The bibliographic resources used consisted on books and magazines of the specialty, as well as the research of articles on PubMed. This disease develops in genetically predisposed individuals, in which a antigen triggers a inflammatory cascade, that results in a exacerbated immune response which translates in a poor quality of life to the patient. The classic therapies, based on the aminossalicilates and steroids, are far from answer to all patient´s needs and, so, the new therapies are taking place. The most promising ones are the biologic agents, targeting specific disease mechanisms. So far, in Portugal Infliximab is the only one used, while in the U.S.A. Certolizumab has also been approved for IBD. Many more are being developed and have been considered potentially efficacious. The dilemma “step up” versus “top down” therapy persists, and should be analyzed individually and according to the clinic’s good sense.
Description
Keywords
Doença inflamatória intestinal Doença inflamatória intestinal - Tratamento Doença inflamatória intestinal - Qualidade de vida Doença inflamatória intestinal - Terapêutica Doença inflamatória intestinal - Cirurgia
Pedagogical Context
Citation
Publisher
Universidade da Beira Interior