Preparo dos pacientes com doença inflamatória intestinal para terapia biológica na prática clínica

  • Júlio Maria Fonseca Chebli Universidade Federal de Juiz de Fora
  • Raphael José da Silva Hospital Universitário da Universidade Federal de Juiz de Fora
  • Bruno Gomes Guércio Hospital Universitário da Universidade Federal de Juiz de Fora
  • Vitor Rocha Couto Hospital Universitário da Universidade Federal de Juiz de Fora
  • Maviel Sousa Pereira Hospital Universitário da Universidade Federal de Juiz de Fora
  • Isaac Nilton Fernandes Oliveira Hospital Universitário da Universidade Federal de Juiz de Fora
  • Gabriela Castro de Rezende Hospital Universitário da Universidade Federal de Juiz de Fora
  • Elaine Jéssica Laranjeira Lima Hospital Universitário da Universidade Federal de Juiz de Fora
Palavras-chave: Doenças Inflamatórias Intestinais, Imunossupressores, Terapia Biológica, Rastreio, Imunização

Resumo

Introdução: A terapia biológica revolucionou o tratamento das doenças inflamatórias intestinais (DII). Embora muito efetivas, as medicações biológicas colocam os pacientes em maior risco de desenvolvimento de reações infusionais e paradoxais, infecções e alguns tipos de câncer como linfomas, este último especialmente quando feita em combinação com tiopurinas. A adequada seleção, aconselhamento e educação dos pacientes são itens importantes para o uso bem sucedido dos biológicos. Objetivo: Revisar a melhor estratégia para mostrar uma visão atualizada das etapas imprescindíveis no preparo dos pacientes com DII para terapia biológica. Material e Métodos: Realizou-se uma revisão sistemática da literatura, em fevereiro de 2018, utilizando os termos de pesquisa: “doença de Crohn”, “doença inflamatória intestinal”, “imunização”, “imunossupressores” e “terapia biológica”, em língua inglesa e portuguesa. Foram incluídos apenas artigos originais e de revisão. Discussão e Conclusão: Uma história detalhada para excluir contraindicações destas medicações e um monitoramento baseado em diretrizes são passos importantes antes de iniciar a terapia. Biológicos devem ser considerados somente se uma avaliação confirmar que o paciente tem doença ativa. É relevante também excluir condições que mimetizam a atividade de doença. Até o momento, os agentes biológicos demonstraram um perfil de segurança favorável em pacientes com DII. No entanto, é importante que o início da terapia biológica seja discutido atentamente com os pacientes, explicando os riscos e benefícios do tratamento. Antes de iniciar o uso de biológicos, os pacientes necessitam ser rastreados para tuberculose latente, hepatites B e C, e infecção por HIV. Idealmente, o status vacinal deve ser verificado e atualizado antes do início da terapia imunossupressora. As diretrizes atuais recomendam aos pacientes adultos com DII o mesmo esquema de imunização de rotina da população geral, evitando as vacinas de agentes vivos durante a terapia imunossupressora. Todas essas medidas são essenciais para estabelecer de forma segura a terapia esperada pelo uso de biológicos.

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Publicado
2019-11-28
Como Citar
Fonseca Chebli, J. M., da Silva, R. J., Gomes Guércio, B., Rocha Couto, V., Sousa Pereira, M., Fernandes Oliveira, I. N., Castro de Rezende, G., & Laranjeira Lima, E. J. (2019). Preparo dos pacientes com doença inflamatória intestinal para terapia biológica na prática clínica. HU Revista, 45(3), 352-366. https://doi.org/10.34019/1982-8047.2019.v45.28789
Seção
Artigos de Revisão da Literatura