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Doença de Crohn: abordagem terapêutica atual e perspetivas futuras
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Abstract(s)
A Doença de Crohn (DC) é uma condição patológica idiopática, pertencente ao grupo das Doenças Inflamatórias Intestinais, que se carateriza pela inflamação da mucosa gastrointestinal, levando ao desenvolvimento de várias manifestações clínicas, como, diarreia, náuseas, vómitos e dor abdominal, e de complicações gastrointestinais, como, por exemplo, o desenvolvimento de abcessos, fístulas e de estenoses intestinais, que afetam, de uma forma significativa, a saúde e a qualidade de vida dos doentes. Até à data, a sua etiologia exata permanece desconhecida, sendo, no entanto, sugerido que a alteração da homeostase intestinal seja resultado de uma interação complexa entre diversos fatores fisiológicos, imunológicos, genéticos e ambientais.
Durante as últimas décadas, a literatura tem vindo a apontar para uma mudança alarmante no padrão epidemiológico da DC, sendo observado globalmente um aumento da sua prevalência. Posto isto, e dado que atualmente não existe cura para a DC, o tratamento centra-se na indução e na manutenção da remissão clínica mediante o uso de aminossalicilatos, corticosteroides, imunossupressores e anticorpos monoclonais.
Embora estes fármacos sejam habitualmente eficazes no tratamento da DC, uma parte dos doentes não apresenta uma resposta terapêutica adequada, sendo necessário o desenvolvimento de estratégias terapêuticas inovadoras que sejam mais eficazes e seguras. Entre as estratégias terapêuticas em desenvolvimento, destaca-se a introdução de novos inibidores das integrinas e inibidores das interleucinas, e a descoberta de terapêuticas inovadoras, como, por exemplo, os inibidores da Janus Associated Kinases, os inibidores da proteína Suppressor of Mothers against Decapentaplegic homolog 7 e os moduladores dos recetores da esfingosina-1-fosfato, bem como do transplante de microbiota fecal e de células estaminais.
O farmacêutico tem um papel essencial no acompanhamento do doente com DC, devendo a sua intervenção ser centrada numa abordagem global das suas necessidades de saúde, de forma a melhorar a sua saúde e a sua qualidade de vida.
Crohn’s Disease (CD) is an idiopathic pathological condition, belonging to the group of Inflammatory Bowel Diseases, which is characterized by the inflammation of the gastrointestinal mucosa. This leads to the development of a variety of clinical manifestations, such as chronic diarrhea, nausea, vomiting, and abdominal pain, as well as gastrointestinal complications, including abscesses, fistulas, and intestinal strictures, that have a significant negative impact on the patient's health and quality of life. Until now, the exact etiology of CD remains unknown. However, it has been proposed that the disease’s expression has a multifactorial nature, with the compromised gastrointestinal homeostasis being the result of a complex interaction between a number of several physiological, immunological, genetic, and environmental factors. During the last decades, the literature has been pointing to an alarming change in the epidemiological pattern of CD, with an increase in its prevalence being seen globally. Given these phenomena and the fact that there is currently no cure for CD, the goal of treatment is to induce and maintain a clinical remission using aminosalicylates, corticosteroids, immunosuppressants and monoclonal antibodies. Even though these medications are typically effective in treating CD, some patients show poor therapeutic response, requiring the development of novel therapeutic strategies that are safer and more effective. The introduction of new integrin inhibitors and interleukin inhibitors and the discovery of novel medicines such as Janus Associated Kinases inhibitors, Suppressor of Mothers against Decapentaplegic homolog 7 inhibitors and sphingosine-1-phosphate receptor modulators, as well as fecal microbiota and stem cell transplantation, are some of the new therapeutic options now being developed. Pharmacists play an essential role in monitoring patients with CD, and their intervention should focus on a global approach to their medical needs, in order to improve their health and quality of life.
Crohn’s Disease (CD) is an idiopathic pathological condition, belonging to the group of Inflammatory Bowel Diseases, which is characterized by the inflammation of the gastrointestinal mucosa. This leads to the development of a variety of clinical manifestations, such as chronic diarrhea, nausea, vomiting, and abdominal pain, as well as gastrointestinal complications, including abscesses, fistulas, and intestinal strictures, that have a significant negative impact on the patient's health and quality of life. Until now, the exact etiology of CD remains unknown. However, it has been proposed that the disease’s expression has a multifactorial nature, with the compromised gastrointestinal homeostasis being the result of a complex interaction between a number of several physiological, immunological, genetic, and environmental factors. During the last decades, the literature has been pointing to an alarming change in the epidemiological pattern of CD, with an increase in its prevalence being seen globally. Given these phenomena and the fact that there is currently no cure for CD, the goal of treatment is to induce and maintain a clinical remission using aminosalicylates, corticosteroids, immunosuppressants and monoclonal antibodies. Even though these medications are typically effective in treating CD, some patients show poor therapeutic response, requiring the development of novel therapeutic strategies that are safer and more effective. The introduction of new integrin inhibitors and interleukin inhibitors and the discovery of novel medicines such as Janus Associated Kinases inhibitors, Suppressor of Mothers against Decapentaplegic homolog 7 inhibitors and sphingosine-1-phosphate receptor modulators, as well as fecal microbiota and stem cell transplantation, are some of the new therapeutic options now being developed. Pharmacists play an essential role in monitoring patients with CD, and their intervention should focus on a global approach to their medical needs, in order to improve their health and quality of life.
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Keywords
Doenças inflamatórias intestinais Doença de crohn Tratamento atual Novas estratégias terapêuticas Cuidados farmacêuticos