特集名 | 潰瘍性大腸炎の治療の最先端 | |
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題名 | SASPの使い方 | |
発刊年月 | 1997年 09月 | |
著者 | 勝又 伴栄 | 北里大学東病院消化器内科 |
著者 | 小林 清典 | 北里大学東病院消化器内科 |
【 要旨 】 | salazosulfapyridine(SASP)は,sulfapyridine(SP)と5-aminosalicylic acid(5-ASA)のアゾ化合物であり,潰瘍性大腸炎に対する治療効果が確認されている.SASPは大腸内常在細菌によりSPと5-ASAに分解吸収され,それぞれ抗炎症作用を発揮する. SASPの臨床効果と副作用は血中総SP濃度と相関し,SP濃度は個体のacetylaterphenotype(rapidまたはslow acetylater)に依存する.5-ASA製剤は副作用が少なく,SASP不耐例にも有効である. SASPの体内動態や副作用の問題も考慮して,潰瘍性大腸炎の活動期および緩解維持期における実際的な使用法と効果判定について論じた.また,SASPの長期維持療法による大腸癌の発生予防効果についても言及した. |
Theme | Advanced Therapy Ulcerative Colitis | |
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Title | Medical Treatment with Salazosulfapyridine for Ulcerative Colitis Patients | |
Author | Tomoe Katsumata | Department of Internal Medicine, Kitasato University East Hospital |
Author | Kiyonori Kobayashi | Department of Internal Medicine, Kitasato University East Hospital |
[ Summary ] | It has been established that salazosulfapyridine (Salazopyrin, SASP) is a useful medicine for the treatment of ulcerative colitis, in both the active and the quiescent phase. Approximentely 70-80% of the ingested SASP reaches the colon, and the azo bond is cleaved by bacterial azoreductases liberating 5-aminosalicylic acid (5-ASA) and sulfapyridine (SP). The clinical benefits and the adverse effects of SASP are related to the total serum SP concentration, which is elevated in patients having the slow acetylater as compared to those with the rapid acetylater phenotype. Based on the metabolism and the adverse effects of SASP, practical SASP treatment for ulcerative colitis patients is discussed herein. Clinical benefits can be anticipated using 3 to 4.5g SASP daily in the active stage of ulcerative colitis. The frequency of adverse effects varies in reports from 6-33% in patients with ulcerative colitis. Several clinical data have proved the usefulness of maintenance therapy with 2g daily of SASP in the quiescent stage of ulcerative colitis. Recently, Moody (1996) reported that patients with ulcerative colitis who had stopped long-term treatment with SASP were significantly more likely to develop colorectal cancer than their compliant counterparts. Maintenance therapy in ulcerative colitis with SASP should be continued unless contraindicated by adverse effects. |