Traitement médical des MICI

Medical management of IBD

Résumé

En 15 ans, les progrès dans le domaine des MICI ont été nombreux, et la pratique a nettement évolué. La thérapeutique a été révolutionnée par l’arrivée des anti-TNF, dont la capacité de cicatrisation n’avait pas jusqu’ici été obtenue par les traitements antérieurs. Par ailleurs, l’apprentissage de leur utilisation, de leurs effets secondaires et la capacité d’élaborer de nouvelles stratégies, en combinaison, ont également bouleversé nos pratiques. Dans le même temps, les objectifs du traitement sont devenus plus ambitieux, avec la nécessité d’obtenir, quand c’est possible et raisonnable, un contrôle muqueux. Ceci est possible par le développement des techniques d’explorations endoscopiques, ou non invasives, grâce à l’IRM et à la calprotectine. Enfin, de nouveaux traitements arrivent ou seront prochainement disponibles, comme les anti-intégrines, les anti-JAK kinases, la thérapie cellulaire. Ceci nécessitera de hiérarchiser leur utilisation, et pour cela de déterminer des facteurs individuels de réponses, et mettre au point des outils de médecine personnalisée.

Abstract

During the last 15 years, numerous progresses in the field of IBD were made, and the practice has evolved significantly. Treatment of IBD has been revolutionized by the advent of anti-TNF, based on their ability to achieve mucosal healing, in contrast with previous treatments. Moreover, the learning of their use, of their side effects and of the way to develop new strategies in combination, has also changed our practices. At the same time, treatment goals have become more ambitious, with the need to obtain, when possible and reasonable, mucosal control of the disease. This was possible by the development of endoscopical techniques but also with non-invasive tools like MRI and fecal calprotectin. Finally, new treatments arrive or will soon be available, such as anti-integrin, anti-JAK kinases and cell therapy. This will need to prioritize their use, and to identify new individual factors of responses to develop a personalized medicine for IBD.

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Références

  1. 1.

    D’Haens G, Van Deventer S, Van Hogezand R, et al (1999) Endoscopic and histological healing with infliximab anti-tumor necrosis factor antibodies in Crohn’s disease: A European multicenter trial. Gastroenterology 116:1029–34

    Article  PubMed  Google Scholar 

  2. 2.

    Present DH, Rutgeerts P, Targan S, et al (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340:1398–405

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Hanauer SB, Feagan BG, Lichtenstein GR, et al (2002) Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet 359:1541–9

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Sands BE, Anderson FH, Bernstein CN, et al (2004) Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 350:876–85

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Rutgeerts P, Sandborn WJ, Feagan BG, et al Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353:2462–76.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Laharie D, Bourreille A, Branche J, et al (2012) Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial. Lancet 380:1909–15

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Colombel JF, Sandborn WJ, Rutgeerts P, et al (2007) Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology 132:52–65

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Colombel JF, Sandborn WJ, Reinisch W, et al (2010) Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med 362:1383–95

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Panaccione R, Ghosh S, Middleton S, et al (2014) Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis. Gastroenterology 146:392–400

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    D’Haens G, Baert F, van Assche G, et al (2008) Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet 371:660–7

    Article  PubMed  Google Scholar 

  11. 11.

    Louis E, Mary JY, Vernier-Massouille G, et al (2012) Maintenance of remission among patients with Crohn’s disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology 142:63–70 e5; quiz e31

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Niess JH, Danese S (2013) Anti-TNF and skin inflammation in IBD: a new paradox in gastroenterology? Gut 63:533–5

    Article  PubMed  Google Scholar 

  13. 13.

    Targownik LE, Bernstein CN (2013) Infectious and malignant complications of TNF inhibitor therapy in IBD. Am J Gastroenterol 108:1835-42, quiz 43

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Beaugerie L, Brousse N, Bouvier AM, et al (2009) Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 374:1617–25

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Peyrin-Biroulet L, Khosrotehrani K, Carrat F, et al (2011) Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease. Gastroenterology 141:1621–28 e1-5

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Kiesslich R, Neurath MF. (2007) Magnifying chromoendoscopy: effective diagnostic tool for screening colonoscopy. J Gastroenterol Hepatol 22:1700–1

    Article  PubMed  Google Scholar 

  17. 17.

    Peyrin-Biroulet L, Ferrante M, Magro F, et al (2013) Results from the 2nd Scientific Workshop of the ECCO. I: Impact of mucosal healing on the course of inflammatory bowel disease. J Crohns Colitis 5:477–83

    Article  Google Scholar 

  18. 18.

    Rutgeerts P. (2003) Strategies in the prevention of post-operative recurrence in Crohn’s disease. Best Pract Res Clin Gastroenterol 17:63–73

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Rimola J, Ordas I, Rodriguez S, et al (2012) Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 17:1759–68

    Article  Google Scholar 

  20. 20.

    Pariente B, Mary JY, Danese S, et al (2015) Development of the Lemann Index to Assess Digestive Tract Damage in Patients With Crohn’s Disease. Gastroenterology 148:52–63.e3. doi: 10.1053/j.gastro.2014.09.015. Epub 2014 Sep 21

    Article  PubMed  Google Scholar 

  21. 21.

    Stragier E, Van Assche G. (2013) The use of fecal calprotectin and lactoferrin in patients with IBD. Review. Acta Gastroenterol Belg 76:322–8

    PubMed  Google Scholar 

  22. 22.

    Feagan BG, Rutgeerts P, Sands BE, et al (2013) Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med 369:699–710

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Vermeire S, O’Byrne S, Keir M, et al (2014) Etrolizumab as induction therapy for ulcerative colitis: a randomised, controlled, phase 2 trial. Lancet 384:309–18

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Gecse KB, Khanna R, van den Brink GR, et al (2013) Biosimilars in IBD: hope or expectation? Gut 62:803–7

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Lee WY, Park KJ, Cho YB, et al (2013) Autologous adipose tissuederived stem cells treatment demonstrated favorable and sustainable therapeutic effect for Crohn’s fistula. Stem Cells 31:2575–81.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to X. Treton.

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Treton, X. Traitement médical des MICI. Colon Rectum 9, 2–7 (2015). https://doi.org/10.1007/s11725-015-0557-z

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Mots clés

  • MICI
  • Anti-TNF
  • Biothérapies
  • Stratégies
  • Explorations

Keywords

  • IBD
  • Anti-TNF
  • Biologics
  • Strategies
  • Explorations