The therapeutic armamentarium for management of inflammatory bowel diseases has expanded dramatically in the last 5 years, with the introduction of several medications with different mechanisms of action. These include the oral small molecule drugs Janus kinase inhibitors (including upadacitinib approved for Crohn’s disease and ulcerative colitis [UC], and tofacitinib, approved for UC) and sphingosphine 1-phosphate receptor modulators (ozanimod and etrasimod, both approved for UC), and biologic agents, such as selective interleukin-23 antagonists (risankizumab approved for Crohn’s disease, and mirikizumab approved for UC). The efficacy and safety of these therapies vary. In this review, we discuss practical use of these newer advanced therapies focusing on real-world effectiveness and safety data, dosing and monitoring considerations, and special situations for their use, such as pregnancy, comorbid immune-mediated disease, use in hospitalized patients with acute severe UC, and in the perioperative setting. We also propose our approach to positioning these therapies in clinical practice, relying on careful integration of the medication’s comparative effectiveness and safety in the context of an individual patient’s risk of disease- and treatment-related complications and preferences.

中文翻译：

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炎症性肠病的现代先进疗法：实际考虑和定位


在过去 5 年中，随着几种具有不同作用机制的药物的引入，用于治疗炎症性肠病的治疗武器急剧扩大。这些药物包括口服小分子药物 Janus 激酶抑制剂（包括批准用于克罗恩病和溃疡性结肠炎 [UC] 的 upadacitinib 和批准用于 UC 的托法替布）和鞘氨醇 1-磷酸受体调节剂（ozanimod 和 etrasimod，均已批准用于 UC）和生物制剂，例如选择性白细胞介素 23 拮抗剂（risankizumab 已获批用于克罗恩病，mirikizumab 已获批用于 UC）。这些疗法的有效性和安全性各不相同。在本综述中，我们讨论了这些新型先进疗法的实际应用，重点关注真实世界的有效性和安全性数据、剂量和监测考虑，以及其使用的特殊情况，例如妊娠、共病免疫介导的疾病、急性重度 UC 住院患者的使用以及围手术期。我们还提出了在临床实践中定位这些疗法的方法，依赖于在个体患者发生疾病和治疗相关并发症的风险和偏好的情况下仔细整合药物的相对有效性和安全性。