| 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 -- Antibiotic Combination ATM Therapy |
| Author |
Toshifumi Ohkusa |
Department of Gastroenterology, Juntendo University School of Medicine |
| Author |
Hiroaki Saito |
Department of Gastroenterology, Juntendo University School of Medicine |
| Author |
Akira Harada |
Department of Gastroenterology, Juntendo University School of Medicine |
| Author |
Kazuko Beppu |
Department of Gastroenterology, Juntendo University School of Medicine |
| Author |
Tomoyoshi Shibuya |
Department of Gastroenterology, Juntendo University School of Medicine |
| Author |
Naoto Sakamoto |
Department of Gastroenterology, Juntendo University School of Medicine |
| Author |
Taro Osada |
Department of Gastroenterology, Juntendo University School of Medicine |
| Author |
Sumio Watanabe |
Department of Gastroenterology, Juntendo University School of Medicine |
| [ Summary ] |
We previously reported that Fusobacterium varium may be one of the pathogenic factors contributing to ulcerative colitis (UC), and that an antibiotic combination therapy against F. varium is effective for active UC. Herein, we assessed whether antibiotic combination therapy is effective for induction and maintenance of remission of UC patients who were dependent on steroids. We enrolled 61 steroid-dependent active UC patients (median age, 36, range, 16 - 73 years, male / female : 41 / 20) whose relapse had occurred during reduction of prednisolone to below 15 mg / day and who were unable to be weaned off steroids without clinical relapse. The patients received amoxicillin 500 mg tds, tetracycline 500 mg tds and metronidazole 250 mg tds for two weeks. We selected these three antibiotics because F. varium was sensitive to them. Sulfasalazine, 5-aminosalicylic acid, prednisolone and / or probiotics being taken at stable dosages for a set time period prior to study inclusion were continued. Symptom assessment (score < 6 indicating clinical remission) and colonoscopic evaluations were performed on a blind before enrollment, as well as at 3 and 12 months after treatment. Fifty of 61 steroid-dependent patients (82 %) showed improvement within 3 months. At 3 and 12 months, 75 % and 61 %, respectively, of steroid-dependent patients were in remission. In the steroid-dependent group, 37 of 60 patients (62 %) were able to stop steroid therapy and maintain remission for 3 months. One patient was excluded from this study because he had nephrosis and could not stop steroid therapy. Four (6.6 %) steroid-dependent patients underwent colectomies. No serious drug related toxicity was observed during the trial. Mean compliance with the antibiotic treatment was 98 % (43 - 100 %). Total colonoscopic findings in both groups showed improvement at 3 and 12 months after treatment (Table 2, p < 0.0001 by Friedman test). The two week antibiotic combination ATM therapy was effective and safe in patients with active ulcerative colitis dependent on steroids in this multicenter, long term follow up study. |