Terapia imunobiológica dupla na doença inflamatória intestinal refratária à terapia de primeira linha

Abstract

The study of Inflammatory Bowel Diseases (IBD) involves the comprehension of a complex interaction between genetic factors, gut microbiota, diet, and the immune system. The treatment of IBD, including Crohn's disease and ulcerative colitis, has evolved with the growing use of combined immunobiological therapies (CoT). These therapies aim to treat severe and refractory forms of the disease, in which conventional treatments have failed. Biological therapies such as anti-tumor necrosis factor therapy (anti-TNF), anti-integrins (such as vedolizumab) and anti-interleukins (such as ustekinumab) have shown good results when used as monotherapy, but combining these treatments may lead to higher rates of clinical remission and mucosal healing. Reviewed studies indicate that combinations such as anti-TNF with vedolizumab or ustekinumab have proven effective in inducing remission, with endoscopic improvements observed in up to 93% of patients. Despite their promising results, CoT still faces challenges, such as the lack of conclusive data on safety and the risk of adverse events. Although initial results suggest that these therapies may reduce the need for more aggressive interventions, such as surgeries, the data remain limited and require further follow-up. CoT has shown particularly good responses in patients with severe IBD, whether with uncontrolled luminal or extra-intestinal manifestations. However, the choice of therapeutic combination should be carefully considered due to the potential for severe adverse effects, such as infections and allergic reactions. Therefore, while combined biological therapies represent a promising strategy, more studies are needed to define their long-term efficacy and safety in the treatment of IBD.