| 特集名 | 潰瘍性大腸炎のTherapeutic Strategy─Standardな治療法から最新情報まで | |
|---|---|---|
| 題名 | ［各論］古くて新しい製剤5-アミノサリチル酸 | |
| 発刊年月 | 2011年 05月 | |
| 著者 | 上野 義隆 | 広島大学病院内視鏡診療科 |
| 著者 | 田中 信治 | 広島大学病院内視鏡診療科 |
| 著者 | 永井 健太 | 広島大学病院消化器・代謝内科 |
| 著者 | 鼻岡 理恵 | 広島大学病院消化器・代謝内科 |
| 著者 | 鬼武 敏子 | 広島大学病院消化器・代謝内科 |
| 著者 | 茶山 一彰 | 広島大学病院消化器・代謝内科 |
| 【 要旨 】 | 5-アミノサリチル酸（5-aminosalicylic acid；5-ASA）製剤は潰瘍性大腸炎治療における第一選択薬である．現在わが国では3種類の経口5-ASA製剤が使用されているが，それぞれが特徴的なドラッグデリバリーシステムを有している．本剤は直接大腸粘膜に到達し，有効性を発揮することから，病態に合わせた用量，投与ルートの選択が重要である．活動期炎症局所での濃度を高めるためには5-ASA注腸療法の併用も効果的である．寛解維持には長期の内服継続が重要であるが，服薬遵守により再燃をきたさないように指導することが重要である． | |
| Theme | Therapeutic strategy for ulcerative colitis ; from standard to up-to-date | |
|---|---|---|
| Title | 5-aminosalicylic acids for ulcerative colitis : Re-evaluation of traditional therapies | |
| Author | Yoshitaka Ueno | Department of Endoscopy, Hiroshima University Hospital |
| Author | Shinji Tanaka | Department of Endoscopy, Hiroshima University Hospital |
| Author | Kenta Nagai | Department of Gastroenterology, Hiroshima University Hospital |
| Author | Rie Hanaoka | Department of Gastroenterology, Hiroshima University Hospital |
| Author | Toshiko Onitake | Department of Gastroenterology, Hiroshima University Hospital |
| Author | Kazuaki Chayama | Department of Gastroenterology, Hiroshima University Hospital |
| [ Summary ] | The current first-line therapy for the induction and maintenance of remission of mild-to-moderate ulcerative colitis (UC) is oral and/or topical mesalazine. Sulfasalazine, a prodrug consisting of a sulfapyridine linked to 5-ASA, was the first available oral mesalazine formulation and has been in use for nearly 60 years. Due to adverse events associated with sulfapyridine moiety, other sulfa-free formulations of 5-ASA were developed. These include the time-dependent release (Pentasa, Kyorin) and pH-dependent release (Asacol, Zeria) formulations. Although the mechanisms of 5-ASA action are unknown, they are thought to be topical. Since 5-ASA formulations are administered multiple times per day, patients often fail to adhere to multiple dose regimens. Patients need to understand that the disease will flare up without continuous maintenance therapy. Another key component of UC treatment plans is the addition of rectal 5-ASA therapies. Although compliance can be very poor with topical therapies, there is a large body of evidence showing that the use of combination therapies provides a faster induction of remission than oral therapies alone. Despite the already established usefulness of these drugs, there is new data emerging to help physicians optimize efficacy, safety, dosing, and adherence to 5-ASA therapies. |
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