| 特集名 | 炎症性腸疾患におけるAZA/6-MPの役割 | |
|---|---|---|
| 題名 | ステロイド依存性／抵抗性炎症性腸疾患におけるAZA/6-MPと他の治療法との比較 (1) シクロスポリン | |
| 発刊年月 | 2007年 11月 | |
| 著者 | 吉村 直樹 | 社会保険中央総合病院内科 |
| 著者 | 鈴木 康夫 | 東邦大学医療センター佐倉病院内科 |
| 著者 | 高添 正和 | 社会保険中央総合病院内科 |
| 【 要旨 】 | 炎症性腸疾患 (IBD) の薬物療法の基本薬は，5-ASA製剤，ステロイド剤である．ステロイドは中等症以上の症例に対しIBD治療の中心的薬剤に位置づけられている．ステロイドにより緩解導入できる症例が増加したが，重症例，難治例に対しては近年，免疫抑制剤の有効性が報告されている．シクロスポリン (CsA) 持続静注療法の導入により，ステロイド抵抗性難治性潰瘍性大腸炎 (UC) 患者の緩解導入率は向上した．一方，アザチオプリンとメルカプトプリン（AZA/6-MP）は以前より難治性クローン病 (CD) に対し有用性が認められているが，UCではCsAによる緩解導入後の緩解維持療法およびステロイド依存性症例のステロイドの減量，中止に有用である． | |
| Theme | Role of AZA/6-MP in the Treatment of Inflammatory Bowel Disease | |
|---|---|---|
| Title | Comparative Effect of Other Treatments with AZA/6-MP in the Steroid Dependent / Resistant Inflammatory Bowel Disease -- Cyclosporin | |
| Author | Naoki Yoshimura | Department of Internal Medicine, Social Insurance Chuo General Hospital |
| Author | Yasuo Suzuki | Internal Medicine, Sakura Medicol center Toho University |
| Author | Masakazu Takazoe | Department of Internal Medicine, Social Insurance Chuo General Hospital |
| [ Summary ] | Ulcerative colitis (UC) is a chronic inflammatory bowel disease of the colonic mucosa. For decades, corticosteroids have been used as the standard treatment for patients with moderate to severe active UC, while patients with severe disease who failed to respond to steroids inevitably had to undergo colectomy. Recently, the immunosuppressive drug cyclosporin (CsA) has been used as an alternative medication in patients with severe steroid refractory UC and has shown efficacy in reducing colectomy rates. Patients who failed to respond to steroid were given intravenous CsA at 3 - 4 mg / kg / day for 14 days. During CsA infusion, the blood level of CsA was adjusted to 400 - 600 ng / ml. Patients who did not show improvement after 14 days of CsA therapy had to undergo colectomy. Patients who clinically and endoscopically responded to CsA were switched to oral CsA at a dose of 8 mg / kg / day (twice the intravenous dose) together with 5-aminosalicylate. Steroid dosage was gradually reduced and oral CsA was discontinued within 6 months of initiation. Intravenous CsA therapy in patients with severe UC is rapidly effective in inducing remission and reducing colectomy rates. However, oral CsA does not show efficacy in maintaining remission. The strategy of adding azathioprine or 6-mercaptopurine (AZA/6-MP) to maintain remission induced by CsA is usually recommended. Further, as AZA/6-MP may take 3 - 4 months to show full efficacy, use of oral CsA as a “bridge therapy” until AZA/6-MP becomes effective may be valuable. |
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