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크론병의 자연경과 및 최신 치료약제

Natural Course of Crohn’s Disease and Novel Treatment Drugs

천재희|이진하
대한내과학회 (The Korean Association Of Internal Medicine)|2013.12|대한내과학회지 (The Korean Journal of Medicine)|제85권 제6호|pp. 578-585|DOI http://dx.doi.org/10.3904/kjm.2013.85.6.578

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키워드

크론병Inflammatory bowel diseaseCrohn’s diseaseNatural history생물학적 제제염증성 장질환자연 경과항 TNF 제제Biologic agentAnti-TNF agent
주제분류내과학

초록

크론병은 질병의 악화와 호전을 반복하다가 대부분의 환자들이 합병증을 동반하고 수술을 요하는 만성적, 진행적인 자연 경과를 보인다. 따라서 크론병의 치료 목표가 과거의 증상 조절에서 질병의 경과 변화로 바뀌었다. 기존의 약제 중에 면역억제제가 질병의 자연경과를 변화시킬 수 있다고 알려져 있으며 최근 병태생리와 새로운 치료법에 대한 많은 연구가 진행되어 infliximab, adalimumab 이외 각종 생물학적 제제의 개발 및 유효한 임상연구 성적이 보고되고 있다. 특히 일부 항 TNF 제제는 질환의 자연 경과를 호전시킨다는 직간접적인 증거들이 있어 향후 생물학적 제제가 크론병의 중추적인 치료제가 될 가능성이 크다. 그러나 항 TNF 제제는 장기간 복용에 따른 부작용과 약효 감소 등의 문제가 있어 다른 기전을 이용한 새로운 약제가 개발되고 이들에 대한 기대와 관심이 증가하고 있다. 이들 약제의 신중한 도입과 동시에 국내 임상연구가 이루어져 한국인에서 적합한 약제의 선택이 중요할 것으로 생각하며 환자의 입장에서 기존에 비해 훨씬 수월하게 투여할 수 있으면서 경제적이고 또한 치료 효과도 우수한 생물학적 제제의 등장이 있을 것으로 기대한다.

Abstract

Crohn’s disease is a chronic recurrent inflammatory disease, mainly affecting the gastrointestinal tract. The pathogenesis of inflammatory bowel disease is believed to be caused by the complex interplay of many factors including host genetic susceptibility, the external environment such as infectious agents or the commensal enteric flora, and the immune system dysfunction. Advances in the understanding of the pathophysiology of inflammatory bowel disease have resulted in the development of multiple biological agents that all represent an alternative to the use of current therapies in patients with refractory Crohn’s disease. Moreover, these biologic agents are expected to change the natural course of inflammatory bowel disease. Among them, anti-tumor necrosis factor (TNF)-α agent is the first developed drug, and it dramatically improved the IBD management. However, more than one-third of the patients do not respond to the drugs due to antibody formation and loss of response. To increase treatment efficacy, enormous efforts have been made to develop novel anti-cytokines which can be an alternative to anti-TNF-α agents. They are anti-CD4＋ T cell cytokines including interleukin (IL)-12/23, IL-17A, and IFN-γ blockers, selective anti-adhesion molecules, anti-inflammatory cytokine IL-10, and immune stimulators. This paper reviews the natural history of Crohn’s disease, natural course modifiers, and the efficacy and safety of biologic agents other than anti-TNF α agents.

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