nieuwe inzichten en behandelingen bij IBD

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Transcript nieuwe inzichten en behandelingen bij IBD

Nieuwe inzichten en
behandelingen bij IBD
Dr Peter Bossuyt
Gastroenterologie
IBD kliniek Bonheiden
Wat nu?
Hetzelfde maar anders
• Optimalisatie van de behandeling
Anders en beter
• Nieuwe behandelingen
Hetzelfde maar anders
• 5-ASA
– Single dose versus split dose
• Steroiden
– “lokaal” werkende versus systemische steroiden
• Purine-analogen
– Imuran versus Puri-Nethol
Hetzelfde maar anders
• Anti-TNF (remicade & humira)
– Mono versus combo
• Antistof vorming
• Effectiviteit
• Duur?
– Vroeg- versus laattijdig
Hetzelfde maar anders
• Anti-TNF (remicade & humira)
– Through levels
anti-TNF level
35
30
25
20
15
10
5
0
anti-TNF level
Type:
Biologicals
Hematopoietic stem
cell transpl/ (ASTic)
ABT-874/J695/
Abbott
Visilizumab/Nu
vion
VT-214/ Viron
Adhesion molecules
Anti-TNF
B Lymphocytes
NovImmune
Abatacept/
Bristol-Mayers
rIL18 BP/ Merck
Serono
PF-00547,659
Rituximab/Roche
Ch5D12/Tanox
Opebacan/Xoma
AntiCD103/
LigoCyte
N1-0401-01/
Cytokine/chemokine
T Lymphocytes
Others
Certolizumab
Celltech-UCB
Adalimumab/
Abbott
Basiliximab/
Cerimon
Thymosin beta4/
RegeneRx
AntiVAP1/BioTie
Tocilizumab
(atlizumab)/Chugai
Vedolizumab
MDX-1100/
Medarex
HuMxIL15/Genmab
Pre-clinic
C326/Avidia
Phase I
smad7/ Giuliani
Millenium
Ustekinumab
(CNTO 1275)/
Centocor
rhuMab
beta7/Genente
ch
Phase II
IPL42/ Inflazyme
NV52/ Novogen
THC:CBD/GW
Pharmaceuticals
Revlimid/Celgene
Guanilib/Callisto
Apilimod mesylate
(STA5236)/Syntha
Small molecules
(MLN0002)/
AIN457/novartis
Laquinimod
Theva
Phase III
CCX282-B /
ChemoCentryx
CP-690,550/Pfizer
Launch
Infliximab/
Centocor/MSD
Natalizumab/
Elan/Biogen
Anders en beter
• Anti-adhesie
Slow down
roll
Integrines become
activated
tethering
chemokinereceptor
chemokines
diapedesis
a4b7-integrin
L-selectin
MadCAM-1
CCX282-B
Chemocentryx
CCR9
Natalizumab (Antegren), Vedolizumab
(Millennium), PF-00547659 MadCam,
rhuMab-beta7 Genentech, human
a4b7 Amgen
Anders en beter
• Anti-inflammatoir
Anders en beter
• Stam cell transplantatie
L
R
Conditioning
Infusion
ATG
Cyclo
endoxan
Conditioning
Infusion
ATG
Cyclo
endoxan
Pre-mobilisation
Phase
Cyclo
endoxan
G-CSF
Post-mobilisation Phase
Mobilisation Phase
Year 1
Year 2
Conditioning and
Transplantation
Phase Group A
M0 (days)
M6
M12
PM0
(days)
PM28
PM34
T0 (weeks)
Conditioning and
Transplantation
Phase Group B
T52
T54
T106
Besluit