염증성 장질환의 소분자제제 치료

• Published in: The Korean journal of gastroenterology Vol. 84; no. 2; pp. 51 - 64
• Main Authors: 전유경, Yu Kyung Jun, 윤혁, Hyuk Yoon
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 31-08-2024
• Subjects: Inflammatory bowel diseases; Janus kinase inhibitors; Sphingosine 1 phosphate receptor modulators; 내과학
• ISSN: 1598-9992; 2233-6869

Small molecules, including Janus kinase (JAK) inhibitors and sphingosine-1-phosphate receptor modulators (S1PRMs), are promising new treatments for inflammatory bowel disease (IBD). Small molecules exhibit more predictable pharmacokinetics than biologics, are less likely to induce immune responses, and can be administered orally. JAK inhibitors function by blocking the activity of JAK enzymes, which prevents the subsequent phosphorylation and activation of signal transducer and activator of transcription (STAT) proteins. Tofacitinib and filgotinib are approved for treating ulcerative colitis (UC), while upadacitinib is approved for UC and Crohn’s disease. Nevertheless, JAK inhibitors can increase the risk of herpes zoster, cancer, major adverse cardiovascular events, and venous thromboembolism. S1PRMs bind to S1PRs, particularly S1PR1, on lymphocytes. This interaction inhibits lymphocytes from exiting the lymph nodes and migrating to the gut, thereby reducing inflammation and the immune response in the intestinal mucosa. Ozanimod and etrasimod are S1PRMs approved for the treatment of UC, but they can cause side effects such as bradycardia, conduction disorder, and macular edema. Overall, JAK inhibitors and S1PRMs offer significant benefits in managing IBD, although their potential side effects require careful monitoring. (Korean J Gastroenterol 2024;84:51-64)