您关于生物学和克罗恩的最佳问题

生物制剂与已知在CroHN疾病中已知的产生蛋白质的特异性炎症产生蛋白质。与类固醇不同，这可能会影响你的整个身体的副作用，生物学靶向一件事：机制推动疾病。生物学有些副作用，有些严重吗？是的。生物学抑制你的免疫系统吗？是的。但他们也只有靶向蛋白质被证明的IBD。

这些生物学目前被美国食品和药物管理局（FDA）批准了克罗恩：

• 抗肿瘤坏死因子（TNF）药剂：Humira（Adalimumab），Cimzia（Certolizumab Pegol）和悔改（英夫利昔单抗）
• Integrin-receptor antagonists: Tysabri (natalizumab) and Entyvio (vedolizumab)
• 白细胞介素-12和-23拮抗剂：Stelara（Ustekinumab）

因为生物学是大蛋白质分子，您不能像传统的化学类药物一样接受它们，具有较小的结构（尚）。“这些真正的大蛋白质不会轻松穿过胃或肠道衬里，所以你不能嘴巴嘴巴。你必须得到一次输液（通过四分之一）或一个皮下注射（拍摄），“费城寺院大学医院炎症性肠病计划的Co-Medical Directram，M.D.Stam C. Ehrlich说。您需要获得灌注或射击的频率基于特定药物和对其的回应而变化。

不要认为你知道如何给自己这些注射之一，建议Elisheva Weiser，R.N.，B.S.N.，他在巴尔的摩的约翰霍普金斯医学与IBD患者合作。值得庆幸的是，您的医生或护士可以帮助您了解如何在自己送完之前给自己注射。事实上，詹森生物技术（Stelara）和abbvie（鬣狗）提供免费护士导航员节目，护士将来到您家，向您展示如何进行。

Your doctor will consider your age as well as whether you have any other health conditions. For example, you won’t receive an anti-TNF biologic if you’ve had heart failure (they’re contraindicated). And, something to know about people already on biologics: Remicade was the first available on the market for Crohn’s disease, in the late 1990s, so if a patient you know has been on it for years, that could be why.

但是除了这些因素呢?很多还不知道n about which biologic might be best for you, according to experts. “We would love some good predictors to say, based on this patient’s genetic makeup, their inflammatory burden, you name it, they’re going to respond better to drug X rather than drug Y. They don’t really exist yet, at least as far as clinical practice,” says Dr. Ehrlich.

一个词：缓解。您将收到的第一个生物学可能是您对最佳的药物 - 但是那个人最终可能会停止工作，researchers say。随着时间的推移，您的身体可能会开始阻止药物的影响。因此，您将切换到另一个以维护缓解。发生在此亚伦拦截器, 27, of Jackson, MS, who has Crohn's. He takes Humira now after starting Remicade in 2010. "I am currently in deep remission," he says. "My scopes are clean, inflammatory markers are normal, and I barely have any symptoms."

Ehrlich博士说，生物制剂工作。“我通常会告诉别人这是50/50，他们会在任何特定的药物上显着更好，有时它更多，或更少，”他说。

没有治愈克罗恩病，随着时间的推移进展肠损伤，它是保持炎症的关键。克罗恩的并发症如瘘管可以用生物学防止脓肿，但通常只有你继续治疗。

Stopping the medication may cause a problematic chain reaction: "The inflammation comes back, patients end up getting scar tissue, and then you get anobstruction, and then you have to have手术“Ehrlich博士说。他告诉他的患者，他们的患者正在”目前“，但在管道中有新的疗法，可能是可能的。”我试图将其分解为一到两年一时，我们正在考虑我们现在要做什么，“他说。

This differs by patient, Dr. Ehrlich says. For patients receiving their first dose of a biologic, they could feel positive effects within two to four weeks. For those receiving ongoing treatment, they're ideally doing well and continuing to do well. "Every patient is a little different, and it also depends on if you get IV versus injection," he says. (Infusions typically work fastest.)

拦截者希望克罗恩的患者有时会意识到，有时候，在经历症状的重大变化之前可能需要数月。他的建议？不要放弃。“很难认为它会立即工作，它没有。耐心，与你的医生开放。”

如前所述，生物学抑制免疫系统，导致感染风险增加。如果您处置抗TNF生物学，医生也将检查潜在结核病和乙型肝炎，因为药物可能导致病毒重新激活。

"I tell patients that they may get a few more colds than usual, and that those colds might last a few days longer, but generally most folks tolerate that very well," Dr. Ehrlich says.

另一种潜在的副作用是注射或输注位点的过敏反应。根据对小鼠观察到的，在人类中，根据对小鼠进行的，在对小鼠中观察到的情况下，在对小鼠的系统性审查中发表的审查后，在人体中进行了小风险Journal of Crohn's and Colitis。

在某些情况下，使用生物药物可能会增加某些癌症的风险。研究表明，发育非霍奇金淋巴瘤和皮肤癌的风险增加。然而，从生物制剂治疗中获得癌症的风险仍然非常小（每10,000例患者 - 每年6.1例。一篇评论）应该称重抵抗潜在的益处。一2011 Cochrane review发现癌症风险几乎没有比一般人群的风险高。

Very. The drug's composition renders it expensive to make. Many insurance companies require preapproval, so check first if this is required, Weiser notes. Your insurance company won't always tell you how much you owe, and if you have deductibles or out-of-pocket expenses, you'll have to meet those before the medication is covered 100%—a tough prospect when Remicade canretailfor $6,000 for five vials at your local pharmacy.

"Many infusion centers have an insurance specialist who can give you a breakdown of what is owed per infusion, so check with the center," Weiser says. "There are copay assistance programs through the manufacture websites that patients with commercial insurance can sign up for and pay as little as $5 per infusion."

希望能够在个体患者中最佳地适用于生物学的更好的可预测性。新疗法也可能在地平线上。

“那里是some new drugs coming out that have different mechanisms, so for people who do not respond to medicines that are currently available, they might have some new options, and they may have some benefits over the current drugs," says Dr. Ehrlich.

另一种可能性？生物学的口头选择。一companyis planning for human trials with its oral technology after successful preclinical studies.

“那里是new things. It's a very exciting time in Crohn's disease [research]."