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
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