粘膜治癒・長期予後の面からみた難治性炎症性腸疾患の治療戦略  [in Japanese] Treatment strategy for refractory inflammatory bowel disease to improve endoscopic lesions and long-term prognosis  [in Japanese]

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Author(s)

    • 長沼 誠 NAGANUMA Makoto
    • 東京医科歯科大学消化器内科 Department of Gastroentrology and Hepatology, School of Medicine, Tokyo Medical and Dental University
    • 藤井 俊光 FUJII Toshimutsu
    • 東京医科歯科大学消化器内科 Department of Gastroentrology and Hepatology, School of Medicine, Tokyo Medical and Dental University
    • 渡辺 守 WATANABE Mamoru
    • 東京医科歯科大学消化器内科 Department of Gastroentrology and Hepatology, School of Medicine, Tokyo Medical and Dental University

Abstract

  潰瘍性大腸炎とクローン病は原因不明であり再燃と寛解を繰り返す難治性炎症性腸疾患である.従来5-アミノサリチル酸製剤,栄養療法,副腎皮質ステロイド剤,チオプリン製剤(アザチオプリン)が治療の中心であったが,近年新しい免疫抑制剤であるタクロリムスや抗TNFa抗体製剤であるインフリキシマブやアダリムマブが開発され,臨床の現場で使用可能となっている.最近では作用機序の弱い薬剤から強い薬剤へステップアップする治療法より抗体製剤のような強力な治療法を早期に導入するトップダウン療法が徐々に行われるようになってきている.抗体製剤は単に症状を改善させるだけでなく,再燃率や手術率の低下にも寄与している.また消化管の粘膜治癒が短期および長期予後を改善することより,粘膜治癒を目標とした治療戦略がより重要になってきている.抗体製剤は潰瘍性大腸炎とクローン病患者に有用である一方で治療効果が減弱する2次無効例が問題であり,インフリキシマブの中和抗体や血中インフリキシマブトラフ濃度測定が2次無効症例の治療を検討していく上で役にたつ可能性がある.<br>

  Ulcerative colitis (UC) and Crohn's disease (CD) is an inflammatory bowel disease of unknown aetiology characterized by periods of remission and acute episodes of relapse with severe inflammation in the colonic mucosa. Conventional treatments for UC and CD include 5-aminosalicylate, corticosteroid, elemental dietary treatment, corticosteroid, and thiopurine (azathioprine). Recently, new immunomodulators and anti-TNFa agents, such as tacrolimus, infliximab, and adalimumab have been developed and these treatments are available to be treated for patients with refractory UC and CD. Conventional step-up treatment has been replaced by top-down treatment using biologics. Infliximab and adalimumab induce not only clinical remission but also improve relapse rates and surgical rates. Endoscopic mucosal healing predicts short- and long-prognosis for both of these diseases, thus recent treatment strategy should be aimed for endoscopic remission. Although biologics is useful for patients with UC/CD, secondary loss of responses (LOR) for biologics has been partly observed in CD patients. Measuring anti-infliximab antibodies and concentration of infliximab trough level may help considering treatment strategy for patients with LOR.<br>

Journal

  • Japanese Journal of Clinical Immunology

    Japanese Journal of Clinical Immunology 35(2), 99-106, 2012-04-28

    The Japan Society for Clinical Immunology

References:  18

Codes

  • NII Article ID (NAID)
    10030573724
  • NII NACSIS-CAT ID (NCID)
    AN00357971
  • Text Lang
    JPN
  • Article Type
    REV
  • ISSN
    09114300
  • Data Source
    CJP  J-STAGE 
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