Fleig W E
Klinik und Poliklinik für Innere Medizin I, Martin-Luther-Universität Halle-Wittenberg.
Med Klin (Munich). 1999 Feb 15;94 Suppl 1:22-5. doi: 10.1007/BF03042029.
The antiinflammatory drug 5-aminosalicylic acid is available either as mesalamine in various slightly different galenic preparations or as a prodrug with 5-ASA bound to a carrier molecule as inert as possible, which releases 5-ASA via bacterial degradation in the ileocolon. Data from therapeutic trials in patients with Crohn's disease are only available for mesalamine and sulfasalazine. In active Crohn's disease, high-dose (> 3 g per day) mesalamine only is more effective than placebo, but inferior to systemic steroids. They may be used in patients refusing treatment with classical steroids or not tolerating them if this does not make a case for budesonide. The therapeutic gain of mesalamine over placebo for the prevention recurrence in patients who have reached remission by drug treatment is marginal. Thus, its use in this clinical situation is not appealing. Results for the maintenance of a surgically induced remission appear slightly better so that the use of > 3 g of mesalamine per day may be still justified in this scenario. It is an unresolved question whether the clinical efficacy of different galenic mesalamine prepations in maintaining postoperative remission varies with the preoperative disease location. Present data are not sufficient to support differential drug treatment based on this parameter.
抗炎药物5-氨基水杨酸可以以多种稍有不同的药剂形式存在，即美沙拉嗪，也可以作为一种前体药物，其中5-氨基水杨酸与尽可能惰性的载体分子结合，该前体药物通过回结肠中的细菌降解释放5-氨基水杨酸。克罗恩病患者治疗试验的数据仅适用于美沙拉嗪和柳氮磺胺吡啶。在活动期克罗恩病中，仅高剂量（>3克/天）美沙拉嗪比安慰剂更有效，但不如全身用类固醇。如果不适合使用布地奈德，它们可用于拒绝使用经典类固醇治疗或不耐受经典类固醇的患者。对于通过药物治疗达到缓解的患者，美沙拉嗪预防复发优于安慰剂的治疗获益微乎其微。因此，在这种临床情况下使用它并不具有吸引力。维持手术诱导缓解的结果似乎稍好一些，因此在这种情况下，每天使用>3克美沙拉嗪可能仍然合理。不同药剂形式的美沙拉嗪制剂在维持术后缓解方面的临床疗效是否因术前疾病部位而异，这是一个尚未解决的问题。目前的数据不足以支持基于该参数的差异药物治疗。
