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Maladies Inflammatoires Chroniques Intestinales (MICI): quelle place pour les traitements conventionnels?

Inflammatory bowel disease (IBD): what is the role of conventional treatments?

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Acta Endoscopica

Résumé

Les traitements conventionnels des MICI incluent les dérivés 5-amino-salicylés, les corticoïdes et les immuno-suppresseurs “conventionnels” (par opposition aux traitements biotechnologiques), appelés “immunomodulateurs” dans la sémantique anglo-saxonne et comprenant essentiellement les thiopurines, le méthotrexate, la ciclosporine et ses analogues.

Nous insisterons sur les indications résiduelles des corticoïdes et les développements récents sur les indications et le bon usage des thiopurines et du méthotrexate, en nous appuyant notamment sur les récentes recommandations européennes et américaines [1–5].

La place des traitements conventionnels s’inscrit dans une stratégie thérapeutique d’ensemble des MICI qui tend á être globalement plus ambitieuse et “agressive”, du fait de la diversification de l’arsenal thérapeutique et du constat de relatif échec des stratégies adoptées auparavant [6]. L’objectif actuel est d’obtenir chez la majorité des patients une rémission clinique stable et prolongée, l’idéal étant qu’un jour l’expression d’une MICI se limite à celle de sa première poussée. Nos traitements n’étant actuellement que suspensifs, cette évolution n’a de sens que si les risques majeurs liés à l’utilisation des traitements immunosuppressers (infections sévères et cancers) sont connus et maitrisés.

Abstract

Conventional treatments for IBD include 5-aminosalicylate derivatives, corticosteroids and ‘conventional’ immunosuppressors (as opposed to biotechnological treatments), called ‘immunomodulators’ which essentially include thiopurines, methotrexate, cyclosporin and cyclosporin analogs.

Here, we focus on the residual indications of corticosteroids and recent developments regarding the indications and good use of thiopurines and methotrexate, notably drawing from the recent European and American recommendations [1–5].

Conventional treatments play a role in therapeutic strategies for IBD, and tend to be giobally more ambitious and ‘aggressive’, due to the diversification of the therapeutic arsenal and the observation of the relative failure of previously adopted strategies [6]. The current objective is to obtain stable, prolonged clinical remission in the majority of patients, with the ideal being that one day the expression of IBD will be limited to the first attack. Since current treatments are only suspensive, this evolution makes sense only if the major risks related to the use of immunosuppressive treatments (severe infections and cancer) are known and mastered.

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  1. Service de gastroentérologie et nutrition, hôpital Saint-Antoine et université Pierre et Marie Curie, 184 rue du Faubourg Saint-Antoine, F-75571, Paris cedex 12, France

    L. Beaugerie

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Beaugerie, L. Maladies Inflammatoires Chroniques Intestinales (MICI): quelle place pour les traitements conventionnels?. Acta Endosc 38, 359–374 (2008). https://doi.org/10.1007/s101900800018

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