Biološka terapija u kroničnoj upalnoj bolesti crijeva u djece

master's thesis

• Title (english): Biological therapy in inflammatory bowel disease in children
• Author: Ivan Rogić
• Mentor: Irena Senečić-Čala (mentor)
• Committee member: Jurica Vuković (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Irena Senečić-Čala (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Crohnova bolest i ulcerozni kolitis danas predstavljaju sve značajnije bolesti u pedijatrijskoj gastroenterologiji. U svakog četvrtog oboljelog od kronične upalne bolesti crijeva dijagnoza je postavljena u dječjoj dobi. Bolesti su agresivnije, zahvaćaju veći dio probavnog trakta i mogu imati značajne posljedice na rast i psihosocijalni razvoj djece. Terapijski pristup mora biti dobro optimiziran i individualiziran svakom pedijatrijskom pacijentu kako bi doveo do brze indukcije remisije te spriječio relaps bolesti. Korištenje konvencionalne terapije sa sobom nosi povećani rizik od brojnih nuspojava i gubitka odgovora na terapiju. Biološki lijekovi napravili su ogroman iskorak u liječenju i kontroli kroničnih upalnih bolesti crijeva u djece. Anti-TNF lijekovi pokazali su se superiornim u indukciji remisije i terapiji održavanja. Lijekovi su se posebno pokazali učinkoviti u terapiji djece kojoj se bolest ne može kontrolirati konvencionalnom terapijom i u težim oblicima bolesti. Preporuke za korištenje anti-TNF lijekova temeljene su na ograničenim ispitivanjima provedenim na pedijatrijskim populacijama. Dosta podataka i dalje proizlazi iz ispitivanja provedenih na odraslim pacijentima. Nuspojave su rijetke, ali kada se jave mogu biti vrlo ozbiljne. Zabilježene su teške infekcije te povećan rizik za razvoj malignosti. Zbog takvih težih nuspojava potrebno je više informacija o dugoročnim posljedicama anti-TNF terapije. Stvaranje protutijela na anti-TNF lijekove i njihov utjecaj na terapiju i dalje je tema mnogih ispitivanja. Protutijela na biološke lijekove povezana su s većom incidencijom infuzijskih reakcija i smanjenjem kliničkog odgovora na terapiju. U zadnjih nekoliko godina na tržištu se pojavljuju bioslični lijekovi koji svojim djelovanjem imaju sličan profil učinkovitosti i sigurnosti kao referentni lijekovi. Oni su oslobođeni skupih licenciranja i moguće ih je proizvesti drugim, usporedivim metodama, što dovodi do smanjenja cijene proizvodnje lijeka.

Abstract (english)

In pediatric gastroenterology today, Crohn’s disease and ulcerative colitis represent increasingly significant diseases. In every fourth patient with chronic inflammatory bowel disease diagnosis is established in childhood. Diseases are more aggressive, affecting larger portions of the intestines and can have significant effects on the growth and psychological development. Therapeutic approach has to be well optimized and individually adjusted so it can rapidly induce remission and prevent disease relapse. Use of conventional therapy carries a risk of numerous side effects and has greater chance for loss of response. Biological medicines made a huge step forward in the treatment and control of chronic inflammatory bowel disease in children. Anti-TNF medicines have shown great benefits in remission induction and maintenance therapy. The treatment is extremely useful in treatment of uncontrollable diseases or in patients who have lost response to conventional therapies. Treatment guidelines are based on limited studies conducted on pediatric patients. High amount of treatment data is drawn from studies on adult patients. Side effects are rare but they can be very serious. There have been severe infections and an increased risk of malignancy. Because of these, more information is required about long-term side effects of anti-TNF therapies. Formation of antibodies on anti-TNF medicines and their influence on therapy is still topic of many studies. Anti-TNF antibodies are associated with higher incidence of infusion reactions and with reduced clinical response to therapy. In the last couple of years’ biosimilar agents have appeared on the market. Biosimilars have the similar efficacy and safety profile as an original agent. They are free of expensive licensing and can be produced through alternative methods, causing reduction in cost of production.

• Keywords: kronična upalna bolest crijeva u djece; biološka terapija; anti-TNF; Crohnova bolest; ulcerozni kolitis; infliksimab; adalimumab; bioslični lijekovi
• Keywords (english): Chronic inflammatory bowel disease in children; biological therapy; anti-TNF; Crohn’s disease; ulcerative colitis; infliximab; adalimumab; biosimilar agents
• Language: croatian
• URN:NBN: urn:nbn:hr:105:831293
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-26 10:52:30