臨牀消化器内科 Vol.31 No.6(1)


特集名 IBD治療のcritical point ― 私ならこうする
題名 IBDの治療薬・治療方針
発刊年月 2016年 06月
著者 加藤 順 和歌山県立医科大学第二内科(
【 要旨 】 炎症性腸疾患にはさまざまな治療法・治療薬が使用されるが,未だ根治させうるような完全な治療法は存在しない.したがって,各治療法の長所・短所をよく知る必要がある.5‒アミノサリチル酸製剤は潰瘍性大腸炎(UC)に対する基準薬であり,時間依存型放出製剤とpH依存型放出製剤がある.ステロイドはUC,クローン病(CD)ともに有効であるが,あくまで寛解導入療法の位置づけである.抗TNFα抗体製剤はCDに対しては非常に有効であるが,UCでは反応しない症例もある.そのほか血球成分除去療法やカルシニューリン阻害薬もUCの治療に使われ,CDでは栄養療法も有用である.両疾患とも維持療法にチオプリン製剤は有効である.また,手術の適応を適切に考慮することも重要である.
Theme How Do You Choose Treatment Strategies for IBD Patients with a Critical Situation?
Title Review of Current Therapeutic Strategies for Inflammatory Bowel Diseases
Author Jun Kato Second Department of Internal Medicine, Wakayama Medical University
[ Summary ] Although several treatment options are available for inflammatory bowel diseases, no treatments are currently available that can achieve complete cure of the diseases. Therefore, physicians have to know the specific characteristics of each treatment option. In particular, 5‒aminosalicylates are a basic treatment option for ulcerative colitis (UC), with two formulations, namely time‒and pH‒dependent release. Corticosteroids should be used exclusively as a remission induction therapy for both UC and Crohn's disease (CD). Anti‒TNF‒α antibodies such as infliximab and adalimumab have potent efficacy for CD, but the effect on UC varies widely among patients. Cytapheresis therapy and calcineurin inhibitors are also effective for UC. On the other hand, nutritional therapy, including parenteral nutrition and elemental diet, still has considerable roles in the treatment of CD. Thiopurines are key drugs for maintenance of both diseases. Surgery has to be considered appropriately when medical treatments are not effective. In the treatment of UC, physicians should note the difference in therapeutic strategy between the remission induction and maintenance phases. Meanwhile, the performance of anti‒TNF‒α antibodies should be optimized in the treatment of CD, with maximum effort to avoid loss of response.
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