INTESTINE Vol.13 No.1(8)

特集名 Intestineの時代到来 -- 今,解決しなければならないIBDの諸問題
題名 VIII. クローン病における生物学的製剤の位置づけ
発刊年月 2009年 01月
著者 吉田 幸治 兵庫医科大学内科下部消化管科
著者 松本 譽之 兵庫医科大学内科下部消化管科
【 要旨 】 クローン病は慢性炎症性腸疾患の一つで発症の原因は不明であり,そのため完治させる治療法は現時点ではなく,腸管炎症の沈静化と維持が目標となる.現在世界中で生物学的製剤が開発,臨床適応され,その画期的な効果から治療の位置付けが変わりつつある.本邦においても例外ではなく栄養療法や5-ASA製剤が治療の中心であったが,抗TNF-alpha抗体製剤であるinfliximabが臨床導入されて以来,多くの症例でその有用性が示されている.その効果は格段で粘膜治癒 (mucosal healing) にもきわめて有効であり,発症早期からinfliximabを投与するtop-down療法はクローン病の自然史を変える可能性も示唆されている.しかしクローン病に対するinfliximab投与については,長期経過も含め,副作用や有効症例の見極めなど十分な注意と検討が必要である.
Theme Now is the time for the "Intestine" -- updates and problems raised to be solved in IBD
Title The position of biologics for Crolin's disease
Author Koji Yoshida The Division of Lower Gastroenterology, Hyogo College of Medicne
Author Takayuki Matsumoto The Division of Lower Gastroenterology, Hyogo College of Medicne
[ Summary ] Since a precise mechanism controlling Crohn's disease has not been clarified, most patients have been treated with nutritional therapy and 5-aminosalicylates in Japan. However, after introducing molecular targeted therapies such as infliximab in late 1990's, treatment strategies for Crohn's disease have changed dramatically.
Infliximab is used not only to induce remission in patients with active Crohn's disease who are refractory to other drugs but also to maintain long term clinical remission. Recent data has shown that the drug is also capable of inducing mucosal healing in substantial subsets of the disease. Although mucosal healing may be an ideal goal to be achieved by first line therapies, early intervention with infliximab for Crohn's disease may be beneficial since those patients are likely to maintain states of remission for long periods. Therefore, this therapy may change the natural history of Crohn's disease. However, infliximab has potential side effects such as infusion reactions and induction of infections including tuberculosis. It is essential to monitor such adverse reactions and use premedication to reduce the risks if necessary.