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Doença inflamatória intestinal: o papel dos medicamentos biológicos na terapêutica
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A Doença Inflamatória Intestinal (DII) é uma doença crónica idiopática que afeta o trato gastrointestinal. Compreende essencialmente dois tipos: a Colite Ulcerosa (CU) e a Doença de Crohn (DC). Os doentes podem apresentar recidivas que contribuem para o dano estrutural da mucosa, sintomas condicionantes e, em casos mais graves, complicações extraintestinais que afetam por completo a sua qualidade de vida e bem-estar.
No que diz respeito ao arsenal terapêutico para estas doenças, existem diversos fármacos disponíveis, tais como: aminossalicilatos, corticosteroides, alguns antibióticos e modeladores do SI responsáveis pela sua supressão (imunossupressores). Para além destes, também a imunoterapia desempenha um papel fundamental na terapêutica da DC e da CU, sobretudo os medicamentos anti TNF-α.
Contudo, nos últimos anos têm surgido novos fármacos e estratégias para lidar com as recidivas e prolongar os estados de remissão clínica e endoscópica da doença. A evolução da mesma depende de vários fatores, porém, sabe-se que uma intervenção precoce e efetiva pode evitar situações complexas e irreversíveis. Têm sido explorados novos biomarcadores e estabelecidos targets que permitem perceber a gravidade da doença no momento antes de iniciar o tratamento e controlar a progressão da mesma ao longo do tempo.
Neste trabalho é feita uma revisão das várias opções existentes na DII, sobretudo no que diz respeito a medicamentos biológicos e o seu papel na terapêutica. São apresentados os seus mecanismos de ação, doses habituais e reações adversas que poderão surgir. Há alturas em que o doente perde a resposta a determinado fármaco, por diversos motivos, sendo que um deles é o aparecimento de imunogenicidade. Neste caso, deve ser analisada a situação e consideradas várias hipóteses, tais como a troca ou a suspensão do medicamento em causa.
O estudo de fatores preditivos e de risco possibilita ao médico fazer a escolha mais acertada no que toca à prescrição do fármaco e à decisão da estratégia a adotar (step up ou top down). No fundo, o ideal é conseguir personalizar o esquema terapêutico e adequá-lo o mais possível a cada doente.
Inflammatory Bowel Disease is a chronic idiopathic disease that affects the gastrointestinal tract. Is essentially comprises two types: Ulcerative Colitis and Crohn’s Disease. IBD patients may experience recurrences that contribute to the structural damage of the mucosa, the emergence of several symptoms and, in more severe cases, the exhibition of extraintestinal complications. These aspects can affect patient’s life quality and well-being. The therapeutic arsenal for these diseases includes several drugs, such as: aminosalicylates, corticosteroids, some antibiotics and immunomodulators (immunosuppressants). In addition, immunotherapy also plays a fundamental role in the treatment of both diseases, especially anti-TNF-α drugs. However, in recent years, new options and strategies have emerged in order to deal with relapses and prolong the disease’s remission state. Its evolution depends on several factor, but i tis known that an early and effective intervention can avoid irreversible and mores complex situations. New biomarkers and targets have been explored, which make it possible to understand the severity of the disease before starting treatment and to facilitate its progression over time. In this review are presented various options to use in IBDs, especially focus on biological drugs and their role in therapy. Its mechanisms of action, appropriate doses and adverse reactions. There are situations that patients lose some response to the therapy chosen, maybe because of immunogenicity or problems related to de dosage. In these cases, the situation must be analysed and considered some options, like readjust the dose, change the medicine or suspend it. Based on the study of predictive and risk factors the doctor can prescribe the drug he considers the most correct choice, as well as defining the adequate strategy for the patient (step up or top down). Basically, in the research of IBD treatment, the ideal is to be able to personalize the therapeutic scheme and to adapt it to each patient.
Inflammatory Bowel Disease is a chronic idiopathic disease that affects the gastrointestinal tract. Is essentially comprises two types: Ulcerative Colitis and Crohn’s Disease. IBD patients may experience recurrences that contribute to the structural damage of the mucosa, the emergence of several symptoms and, in more severe cases, the exhibition of extraintestinal complications. These aspects can affect patient’s life quality and well-being. The therapeutic arsenal for these diseases includes several drugs, such as: aminosalicylates, corticosteroids, some antibiotics and immunomodulators (immunosuppressants). In addition, immunotherapy also plays a fundamental role in the treatment of both diseases, especially anti-TNF-α drugs. However, in recent years, new options and strategies have emerged in order to deal with relapses and prolong the disease’s remission state. Its evolution depends on several factor, but i tis known that an early and effective intervention can avoid irreversible and mores complex situations. New biomarkers and targets have been explored, which make it possible to understand the severity of the disease before starting treatment and to facilitate its progression over time. In this review are presented various options to use in IBDs, especially focus on biological drugs and their role in therapy. Its mechanisms of action, appropriate doses and adverse reactions. There are situations that patients lose some response to the therapy chosen, maybe because of immunogenicity or problems related to de dosage. In these cases, the situation must be analysed and considered some options, like readjust the dose, change the medicine or suspend it. Based on the study of predictive and risk factors the doctor can prescribe the drug he considers the most correct choice, as well as defining the adequate strategy for the patient (step up or top down). Basically, in the research of IBD treatment, the ideal is to be able to personalize the therapeutic scheme and to adapt it to each patient.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2020, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Doença inflamatória intestinal Medicamentos biológicos Step-up Top-down Treat to target Mestrado integrado - 2020