| 特集名 | 潰瘍性大腸炎における新たな治療戦略 | |
|---|---|---|
| 題名 | シクロスポリン | |
| 発刊年月 | 2013年 03月 | |
| 著者 | 吉村 直樹 | 社会保険中央総合病院内科・炎症性腸疾患センター |
| 著者 | 高添 正和 | 社会保険中央総合病院内科・炎症性腸疾患センター |
| 【 要旨 】 | シクロスポリン（CsA）の導入でステロイド大量投与に反応しない重症難治性潰瘍性大腸炎（UC）の約80％で手術が回避でき，寛解導入率は向上した．ステロイド抵抗性重症難治性UCの手術回避においてはこれまでCsA持続静注療法がもっとも有用な治療戦略であったが，新たにタクロリムス（Tac），抗体製剤インフリキシマブ（IFX）が保険適用になり治療選択肢は広がった．しかし，各種薬剤の位置づけについてはまだ明確なコンセンサスはない．CsAは保険適用外の薬剤であるため使用も専門施設に限られるが，迅速かつ強力な寛解導入効果を持ち合わせており重症・劇症例においてはIFX，同じカルシニューリン阻害薬Tacよりも高い手術回避率が期待できる． | |
| Theme | Novel therapeutic strategy for ulcerative colitis | |
|---|---|---|
| Title | The short-term efficacy and positioning of intravenous cyclosporine therapy in patients with severe steroid-refractory ulcerative colitis | |
| Author | Naoki Yoshimura | Department of Internal Medicine, Division of IBD, Social Insurance Central General Hospital |
| Author | Masakazu Takazoe | Department of Internal Medicine, Division of IBD, Social Insurance Central General Hospital |
| [ Summary ] | Recently, the immunosuppressive agent, cyclosporineA (CsA) has been introduced as an alternative medication for patients with severe steroidrefractory ulcerative colitis (UC). Up to 80 % of patients with severe UC are refractory to steroid treatment and respond to CsA, potentially avoiding colectomies. It would appear that rates of remission in patients with severe UC improve with CsA therapy. At this time, the calcineurin inhibitors, tacrolimus (Tac), anti-TNF antibody and infliximab (IFX) have been approved as rescue therapies to avoid colectomies for patients with severe UC who have failed to respond to steroid treatment. However, there is little evidence to prove clinical comparative responses to these three medications. In terms of remission rates for severe UC cases in the CsA group, 40 out of 53 patients in the severely affected group (75.5 %) and 10 out of 19 in the fluminant group (52.6 %) achieved induced remission versus 19 out of 23 (82.6 %) and 2 out of 7 (28.6 %) in the Tac group, as well as 12 out of 15 (80 %) and 1 out of 4 (25.0 %) in the IFX group. In terms of management for patients with severe UC, the initial efficacy and safety of CsA, Tac and IFX showed no significant difference. For fluminant UC therapy, CsA treatment may be superior in terms of avoiding colectomies. |
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