臨牀消化器内科 Vol.22 No.12(5)


特集名 炎症性腸疾患におけるAZA/6-MPの役割
題名 炎症性腸疾患に対するAZA/6-MPのオーダーメイド療法と副作用および使用上の留意点
発刊年月 2007年 11月
著者 岡村 正造 豊橋市民病院消化器内科
著者 古川 和宏 豊橋市民病院消化器内科
著者 山田 雅弘 豊橋市民病院消化器内科
著者 北畠 秀介 豊橋市民病院消化器内科
著者 坂巻 慶一 豊橋市民病院消化器内科
著者 浦野 文博 豊橋市民病院消化器内科
【 要旨 】 臨床効果をみながらアザチオプリン(AZA)/6-メルカプトプリン(6-MP)の投与量を白血球数が2,500 - 5,000/mm3内に向くよう個々に調節するオーダーメイド療法により，クローン病では76.7 %，潰瘍性大腸炎では90.5 %の有効率を得た．副作用は90例中27例，30 %に出現し，4週以内では胃腸症状と倦怠感が多く，5週以後では白血球減少が最多で，ほかに貧血，肝障害，抜毛，膵炎，帯状疱疹，頭痛を経験した．白血球減少の発現時期は11例中9例が6週から4ヵ月後で，最長13ヵ月後であった．27例中2例は中止となったが，10例は薬剤の変更・減量，12例は中断後減量して再開し効果を得た．以上よりAZA/6-MPのオーダーメイド療法は有効かつ注意を怠らなければ安全な優れた治療法と考えられた．
Theme Role of AZA/6-MP in the Treatment of Inflammatory Bowel Disease
Title The Tailoring Therapy, Adverse Events and Points to Keep in Mind of AZA/6-MP for the Treatment of Inflammatory Bowel Disease
Author Shozo Okamura Division of Gastroenterology, Toyohashi Municipal Hospital
Author Kazuhiro Furukawa Division of Gastroenterology, Toyohashi Municipal Hospital
Author Masahiro Yamada Division of Gastroenterology, Toyohashi Municipal Hospital
Author Shusuke Kitabatake Division of Gastroenterology, Toyohashi Municipal Hospital
Author Keiichi Sakamaki Division of Gastroenterology, Toyohashi Municipal Hospital
Author Fumihiro Urano Division of Gastroenterology, Toyohashi Municipal Hospital
[ Summary ] We tried the tailoring therapy in which the given dosage of AZA/6-MP is adjusted according to individual white blood cell count so that it may turn to 2,500 to 5,000 / mm3. The rate of effectiveness was 76.7 % in Crohn's disease, and 90.5 % in ulcerative colitis. There were side effects in 27 out of 90 patients (30 %). The major side effects, which appeared within 4 weeks, were gastrointestinal symptoms and fatigue. After the 5th week, leukopenia was the most frequent Complication followed by anemia, liver dysfunction, hair loss, pancreatitis, herpes zoster and headache. Leukopenia was observed from 6 weeks to 4 months after initiation of medication in 9 of 11 cases. The latest onset was 13 months after initiation of medication. Although medication was stopped in 2 of 27 cases, dose reduction and / or exchange of the drugs was effective in 10 cases and dose reduction after interruption of the drugs was also helpful in 12 cases. In conclusion tailoring therapy of AZA/6-MP under strict investigation was considered to be a safe and efficient treatment for IBD.
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