發炎性腸道疾病的免疫生物製劑治療

Immunomodulators and Biologics for Inflammatory Bowel Diseases

近來由於西化的飲食（高脂，高甜度）衝擊及環境衛生改善（減少了腸道在成人期間之前免疫系統的刺激與教育），發炎性腸道疾病的患者有日漸增多的趨勢。由潰瘍性大腸炎（ulcerative colitis）及克隆氏症（Crohn’s disease）所造成的慢性腸道發炎疾病，總稱為發炎性腸道疾病（IBD）。患有此種症狀的病友，需要長期的藥物控制、定期的腸鏡追蹤。近二十年來，對此疾病的致病機轉漸漸增加了解，也由此衍生新的治療，如免疫調節及生物製劑。對中重度患者，經由免疫調節及生物製劑的使用，的確可促進腸道粘膜的癒合，因此改善病人的治療效果降低住院／手術，進而改善病人的生活品質。目前可使用於治療發炎性腸道疾病的生物製劑有：腫瘤壞死因子抗體，整合素抗體，介白素23抗體幾大類。經由這些生物製劑的使用，治療效果可大幅提升，但仍有許多待解決的問題（非全部病人都有效，使用一陣子之後療效降低，費用高所以健保僅給付部分時間…）有待將來的研究解決，以造福更多的病患。 Abstract: Recently, the incidence and prevalence of inflammatory bowel disease (IBD) increased as a world wide trend. It probably associated with the western style diet (high fat and sweet) as well as the improved hygiene. Ulcerative colitis (UC) and Crohn’s disease (CD) are the two major forms of inflammatory bowel disease. As a chronic disease, IBD patients need long term medical treatment and regular endoscopic monitoring. In recent two decades, with the increasing understanding of the pathophysiology of IBD, novel treatment has been developed, for example, the biologics. For moderate to severe disease IBD patients, treating with immunomodulators and biologics, the treatment goal as mucosal healing could be achieved in order to decrease the admission/surgical rate, as well as to improve the life quality of the patients. Currently, there are several kinds of biologics (TNF-a antibody, Interleukin 23 antibody, and Integrin antibody). With these biologics, the treatment efficacy could increase dramatically. However, there are still unmet needs, for example, not all patients could respond to the treatment (primary failure), secondary failure (lost of response during the maintenance therapy) and high cost that not all patients could afford the lifelong use…). Further studies and government’s policy modification are needed to solve these unmet needs.

Abstract: Recently, the incidence and prevalence of inflammatory bowel disease (IBD) increased as a world wide trend. It probably associated with the western style diet (high fat and sweet) as well as the improved hygiene. Ulcerative colitis (UC) and Crohn’s disease (CD) are the two major forms of inflammatory bowel disease. As a chronic disease, IBD patients need long term medical treatment and regular endoscopic monitoring. In recent two decades, with the increasing understanding of the pathophysiology of IBD, novel treatment has been developed, for example, the biologics. For moderate to severe disease IBD patients, treating with immunomodulators and biologics, the treatment goal as mucosal healing could be achieved in order to decrease the admission/surgical rate, as well as to improve the life quality of the patients. Currently, there are several kinds of biologics (TNF-a antibody, Interleukin 23 antibody, and Integrin antibody). With these biologics, the treatment efficacy could increase dramatically. However, there are still unmet needs, for example, not all patients could respond to the treatment (primary failure), secondary failure (lost of response during the maintenance therapy) and high cost that not all patients could afford the lifelong use…). Further studies and government’s policy modification are needed to solve these unmet needs.