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

Autores

  • 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

DOI:

https://doi.org/10.34019/1982-8047.2019.v45.28789

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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2019-11-28

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Fonseca Chebli JM, da Silva RJ, Gomes Guércio B, Rocha Couto V, Sousa Pereira M, Fernandes Oliveira IN, Castro de Rezende G, Laranjeira Lima EJ. Preparo dos pacientes com doença inflamatória intestinal para terapia biológica na prática clínica. HU Rev [Internet]. 28º de novembro de 2019 [citado 29º de março de 2024];45(3):352-66. Disponível em: https://periodicos.ufjf.br/index.php/hurevista/article/view/28789

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