伊曲莫德的适应症

Itramod is a new oral selective sphingosine-1-phosphate receptor modulator, mainly targeted at adults with moderately to severely active ulcerative colitis. The drug effectively reduces intestinal inflammatory response by regulating lymphocyte migration, and significantly improves the patient's clinical symptoms and endoscopic manifestations. Itrimod's once-daily oral administration provides patients with a convenient treatment option, especially for patients who have failed previous treatments with biologics or JAK inhibitors, and it still shows good efficacy.

Efficacy and role of Itrimod

It exerts therapeutic effect through a unique pharmacological mechanism and shows multiple clinical benefits in improving the symptoms of ulcerative colitis.

Regulate lymphocyte migration

Itramod selectively acts on S1P1, S1P4 and S1P5 receptors, promoting lymphocyte retention in lymph nodes and reducing the migration of peripheral blood lymphocytes to the inflamed intestine. This effect can reduce circulating lymphocyte counts, thereby reducing intestinal inflammatory response.

Significant improvement in clinical symptoms

Clinical studies show that the clinical remission rate is higher at 12 weeks of treatment with itramod. By 52 weeks, the clinical remission rate is further improved and is significantly better than the placebo group. The frequency of bloody stools and abdominal pain symptoms reported by patients usually begin to improve within 4 weeks of treatment.

Sustained inflammation control

The half-life of Itrimod is about 30 hours, which can maintain stable blood concentration. Long-term follow-up data show that its therapeutic effect lasts for at least 1 year and is still effective in patients who have failed previous treatment with biological agents or JAK inhibitors.

Itramod not only effectively controls the symptoms of ulcerative colitis by precisely regulating the immune response, but its convenient administration and sustained efficacy provide patients with a long-term disease management solution.

Itrimod’s use in special populations

The use of itramod in different groups needs to take into account individual differences. Reasonable adjustment of the medication strategy can optimize the treatment effect and reduce risks.

Pregnant and lactating women

Animal experiments show that itrimod is teratogenic and is contraindicated in pregnant women. Women of childbearing age should take effective contraceptive measures during treatment and for 1 week after stopping the drug. Breastfeeding women should weigh the benefits of breastfeeding against the potential risks and suspend medication if necessary.

Elderly patients

The pharmacokinetics of elderly patients over 65 years old are similar to those in younger patients, but clinical data are limited (only 30 cases ≥65 years old). Intensive monitoring is recommended when initiating treatment, particularly with regard to heart rate and risk of infection.

Patients with hepatic and renal impairment

No dose adjustment is required for mild to moderate hepatic impairment (Child-Pugh A/B). It is contraindicated in patients with severe hepatic impairment (Child-Pugh class C) due to a 57% increase in drug exposure. No dose adjustment is required in patients with renal impairment, including severe renal insufficiency (eGFR ≤ 29 mL/min).

The use of itramod in special populations requires individualized evaluation and strict compliance with medication recommendations.

Contraindications of Itrimod

Itrimod has limitations in its use in specific disease states, and identifying these contraindications is critical to preventing serious adverse events.

Severe cardiovascular disease

It is contraindicated in patients with myocardial infarction, unstable angina, stroke or TIA within the past 6 months. Patients with Mohs type II second or third degree atrioventricular block and sick sinus syndrome who do not have a pacemaker are also contraindicated.

Contraindications for the combination of specific drugs

It is prohibited to use it in combination with strong CYP2C9/CYP3A4 inhibitors (such as fluconazole) or inducers (such as rifampicin), as it will significantly change drug exposure. It is also contraindicated to use CYP2C8/CYP3A4 inhibitors in combination with poor metabolizers of CYP2C9.

Active infection

Susceptible patients who have not completed varicella-zoster virus vaccination should withhold treatment. Patients with active severe infections need to control the infection before considering medication, and avoid using live attenuated vaccines during treatment.

The contraindications of istrimod involve cardiovascular, metabolic and immune status and other factors, and patients should strictly follow these restrictions.