Nieuwe inzichten en behandelingen bij IBD

Dr Peter BossuytGastroenterologie

IBD kliniek Bonheiden

Hetzelfde maar anders• Optimalisatie van de behandeling

Anders en beter• Nieuwe behandelingen

Wat nu?

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

week 0

week 2

week 4

week 6

week 8

week 2

week 4

week 6

week 805

101520253035

anti-TNF level

anti-TNF level

Pre-clinic Phase I Phase II Phase III Launch

Biologicals

Small molecules

Natalizumab/Elan/Biogen

Apilimod mesylate (STA5236)/Syntha

Cytokine/chemokine

Adhesion molecules

T Lymphocytes

Anti-TNFB Lymphocytes

Others

Vedolizumab

(MLN0002)/

Millenium

ABT-874/J695/Abbott

N1-0401-01/

NovImmune

Adalimumab/Abbott

Rituximab/Roche CertolizumabCelltech-UCB

Infliximab/Centocor/MSD

Abatacept/Bristol-Mayers

CCX282-B /ChemoCentryx

THC:CBD/GW Pharmaceuticals

Tocilizumab (atlizumab)/Chugai

Opebacan/Xoma

C326/Avidia

MDX-1100/

Medarex

NV52/ Novogen

AntiVAP1/BioTie

Guanilib/Callisto

rIL18 BP/ Merck Serono

VT-214/ Viron

HuMxIL15/Genmab

Thymosin beta4/ RegeneRx

IPL42/ Inflazyme

Revlimid/Celgene

AntiCD103/

LigoCyte

rhuMab beta7/Genentech

Ustekinumab (CNTO 1275)/ Centocor

Basiliximab/

Cerimon

Ch5D12/Tanox

AIN457/novartis

CP-690,550/Pfizer

Type:

smad7/ Giuliani

Hematopoietic stem cell transpl/ (ASTic)

PF-00547,659

Visilizumab/Nuvion

LaquinimodTheva

Anders en beter• Anti-adhesie

Slow down roll Integrines become activated

diapedesis

L-selectinchemokines

chemokine-receptor

MadCAM-1

a4b7-integrin

Natalizumab (Antegren), Vedolizumab (Millennium), PF-00547659 MadCam, rhuMab-beta7 Genentech, human a4b7 Amgen

CCX282-BChemocentryxCCR9

tethering

Anders en beter

• Anti-inflammatoir

Anders en beter

Cyclo

ATG

InfusionConditioning

Cyclo

ATG

InfusionConditioningL R

Cyclo G-CSF

Pre-mobilisation Phase

Mobilisation Phase Post-mobilisation Phase

Conditioning and Transplantation Phase Group A

Year 1

Conditioning and Transplantation Phase Group B

Year 2

PM28M0 (days)

T52

M12PM0 (days) PM34

T0 (weeks) T54 T106

M6

endoxan

endoxan

endoxan

• Stam cell transplantatie

Besluit