INTESTINE Vol.20 No.1(10)

特集名 『早期大腸癌』からの20年,『INTESTINE』からの今後20年
題名 クローン病診療の将来像
発刊年月 2016年 01月
著者 鈴木 康夫 東邦大学医療センター佐倉病院内科
【 要旨 】 過去20年間のクローン病(CD)診療における最大の収穫は,抗TNF-α抗体製剤の画期的治療成果の実証である.すでに抗TNF-α抗体製剤はCD治療の中心薬剤として汎用され,抗TNF-α抗体投与によって従来達成困難とされた粘膜治癒が標準的治療目標となった.抗TNF-α抗体を凌駕する新規薬剤が早々に登場することは期待できず,今後は抗TNF-α抗体製剤の血中濃度をモニタリングし的確な投与量に調節しながら治療効果の最大化を目指すことになる.さらに,抗TNF-α抗体製剤一次無効や二次無効症例に対しては,抗インテグリン抗体製剤やTNF-α以外の炎症惹起性サイトカインを標的とした新規薬剤が登場し,個々のCD患者の病態に即した治療薬剤の選択すなわちtailor-made治療が可能になる.診断法においては,腸管全層性変化とともに病勢の推移や予後を的確に判断し患者負担の軽減化された画像診断法に,遺伝子診断や腸内細菌叢解析を含む各種biomarkerを組み合わせた,CD phenotypeの区別可能な新規診断法が確立されることが期待される.
Theme "Early Colorectal Cancer" and "Intestine", Road to future
Title Present and possible future concepts concerning Crohn's disease
Author Yasuo Suzuki Department of Internal Medicine, Sakura Medical Center, Toho University
[ Summary ] The greatest achievement in Crohn disease (CD) treatment since the past 20 years is the remarkably good outcome of anti-tumor necrosis factor (TNF)-α antibody treatment. Anti-TNF-α antibody has already been widely used as the most important CD treatment agent. Currently, achieving mucosal healing is the standard treatment goal that could hardly be achieved by treatment methods other than that using the anti-TNF-α antibody.
In the near future, we cannot expect new therapies with therapeutic effects better than those of the anti-TNF-α antibody therapy;hence, we must maximize the effects of the anti-TNF-α antibody therapy by adjusting the dosage by monitoring the blood levels.
For CD patients who are resistant to the anti-TNF-α antibody therapy or show loss of response during the maintenance treatment, anti-integrin antibody or new medicines targeting inflammatory cytokines other than TNF-α will need to be used. Tailor-made therapies for individual CD patients who have variably different pathological conditions can be used.
In the field of diagnostics, the establishment of new imaging methods that can not only diagnose whole intestinal inflammatory conditions but also accurately determine the trends and long-term prognosis of the disease course, as well as new diagnostic methods that can differentiate the phenotype of CD and use various biomarkers for genetic diagnosis and intestinal flora analysis is expected.