臨牀消化器内科 Vol.12 No.10(6)


特集名 潰瘍性大腸炎の治療の最先端
題名 免疫療法
発刊年月 1997年 09月
著者 矢島 知治 慶應義塾大学医学部消化器内科
著者 日比 紀文 慶應義塾大学医学部消化器内科
【 要旨 】 潰瘍性大腸炎に対するサラゾスルファピリジン,副腎皮質ステロイドを主体とした従来の薬物療法は,ある程度有効ではあるが,一部に難治例,ステロイド離脱困難な症例がみられる.こうした症例に対し,免疫抑制剤の投与が試みられており,その有効性が確立しつつある.6-MPあるいはアザチオプリンの少量投与は,ほとんど副作用をみることなく長期的に良好な治療効果をもたらすが,効果発現が緩徐なため,緩解導入よりも,緩解の維持やステロイド離脱を目的として用いることが多い.一方,シクロスポリンは治療効果が高く即効性があるが,長期使用には難がある.これらの薬剤の特徴を踏まえたうえで治療に組み入れることでより適切な内科的治療が可能となる.
Theme Advanced Therapy Ulcerative Colitis
Title Immunomodulator Therapy for Ulcerative Colitis
Author Tomoharu Yajima Department of Internal Medicine, Keio University School of Medicine
Author Toshifumi Hibi Department of Internal Medicine, Keio University School of Medicine
[ Summary ] Standard medical treatment for ulcerative colitis includes 5-aminosalicylic compounds and corticosteroids. Although both drugs have proved effective for ulcerative colitis, immunosuppressive drugs are needed for patients who are either refractory or intolerant to traditional medical therapy. 6-mercaptopurine and azathioprine have been shown to be effective in ulcerative colitis even when used at low doses. Serious side effects are very rare. Their optimal effect is, however, reached only after a few months of treatment. Therefore, they are not suitable for treating the acute phase of the disease. In contrast, cyclosporine has a rapid onset of action. It has successfully been used in the treatment of severe active ulcerative colitis refractory to intravenous corticosteroids. However, long-term efficacy of cyclosporine is questionable, and the side effects become significant with long-term use. With adequate understanding of the characteristics of such immunomodulating agents, the combination of conventional drugs and immunosuppressive agents leads to better management of refractory ulcerative colitis cases.
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