| 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 -- Tacrolimus |
| Author |
Hiroshi Nakase |
Department of Gastroenterology and Hepatology, Kyoto University Hospital |
| Author |
Tsutomu Chiba |
Department of Gastroenterology and Hepatology, Kyoto University Hospital |
| [ Summary ] |
Tacrolimus (FK 506, tukubaneolide) is a macrolide antibiotic which was isolated from the fungus Streptomyces tsukubaensis in 1984. Its mechanism of action is similar to cyclosporin A (CyA) but has a one hundred fold greater immunosuppressive effect than CyA. This immunosuppressive drug has been widely used for the prevention of allograft rejection in patients undergoing liver transplantation. Recently, tacrolimus has been approved for autoimmune diseases such as rheumatoid arthritis, myasthenia gravis, and lupus nephritis. Additionally, several case reports and uncontrolled studies have shown the efficacy of tacrolimus for refractory inflammatory bowel disease (IBD) including patients with steroid-resistant inflammatory bowel disease. These clinical studies suggest that tacrolimus is expected to be effective in inducing remission of refractory IBD in relation to more rapid onset of action compared to azathioprine (AZA). Therefore, combination therapies with tacrolimus plus AZA/6-MP or tacrlimus or can lead to the rapid discontinuation of corticosteroids and long-term remission in patients with refractory IBD. However, more studies are necessary to clarify whether or not this combination therapy is safe. |