Meuwissen S G, Ewe K, Gassull M A, Geboes K, Jewell D, Pallone F, Rachmilewitz D, Rask-Madsen J, Riddell B H, Sandborn B J, Schmuck M L
International Organization for the Study of Inflammatory Bowel Disease, Department of Gastroenterology, University Hospital, Vrije Universiteit, Amsterdam, The Netherlands.
Eur J Gastroenterol Hepatol. 2000 Jan;12(1):13-8. doi: 10.1097/00042737-200012010-00004.
To obtain information on the clinical experience with azathioprine (AZA), 6-mercaptopurine (6-MP), cyclosporin A (CyA) and methotrexate (MTX) in the treatment of patients with inflammatory bowel disease (IBD) by gastroenterologists and internists in different countries.
A questionnaire designed by the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) was mailed to 300 gastroenterologists, living in North America (n = 76) and Europe (n = 224) (12 countries), to obtain information on clinical experience.
More than half of the respondents (168/298; 56.4%) worked in university hospitals and 58/298 (19.5%) in general (non-university) hospitals. Two-thirds (65%) had more than 10 years' experience in gastroenterology.
The respondents had personal experience with AZA (88.4%), 6-MP (33.3%), CyA (48.7%) and MTX (36.3%). AZA was prescribed more frequently in Europe (92.6%) than in North America (74.2%) (P = 0.0002), 6-MP less frequently by the European than the North American respondents (23.8 and 53.3% respectively, P = 0.0001). Two-thirds (69.7%) usually prescribed AZA together with steroids to Crohn's disease patients; 62.4% of the respondents prescribed AZA for periods longer than 24 months. For ulcerative colitis, 77.9% had experience with AZA (Europe > North America, P = 0.0001). AZA had been prescribed by 69 respondents to pregnant patients, without apparent toxicity. Acute pancreatitis had been observed after AZA by 56.7% respondents; 25 malignancies were mentioned (six lymphoma, three leukaemia, three colon cancer, four renal carcinoma, nine others). CyA had been prescribed in acute ulcerative colitis by 140/291 respondents (North America 45.1%, Europe 49.1 %); of all respondents 63.9% treated < 5 patients with CyA, 36.1% 6-20 cases. CyA results were considered good in 29.5%, acceptable but with recurrences in 58.6%, and poor in 14.3%. MTX was prescribed in North America by 47.8% of the respondents, and by 33.9% in Europe (not significant). Several significant differences were observed between the prescription behaviour of respondents working at university hospitals and non-university hospitals, in particular in relation to participation in clinical trials.
Considerable experience exists in the use of immunosuppressive therapy in IBD; however, differential prescription behaviour exists in the choice of immunosuppressives between North America and Europe. These IOIBD study results may contribute to a better insight in the daily use of immunosuppressive agents in IBD by gastroenterologists and other specialists.
获取不同国家的胃肠病学家和内科医生使用硫唑嘌呤（AZA）、6-巯基嘌呤（6-MP）、环孢素A（CyA）和甲氨蝶呤（MTX）治疗炎症性肠病（IBD）患者的临床经验信息。
由国际炎症性肠病研究组织（IOIBD）设计的一份问卷被邮寄给300名居住在北美（n = 76）和欧洲（n = 224）（12个国家）的胃肠病学家，以获取临床经验信息。
超过一半的受访者（168/298；56.4%）在大学医院工作，58/298（19.5%）在普通（非大学）医院工作。三分之二（65%）的人有超过10年的胃肠病学经验。
受访者有使用AZA（88.4%）、6-MP（33.3%）、CyA（48.7%）和MTX（36.3%）的个人经验。AZA在欧洲（92.6%）的处方频率高于北美（74.2%）（P = 0.0002），6-MP在欧洲受访者中的处方频率低于北美受访者（分别为23.8%和53.3%，P = 0.0001）。三分之二（69.7%）的人通常将AZA与类固醇一起用于克罗恩病患者；62.4%的受访者使用AZA的时间超过24个月。对于溃疡性结肠炎，77.9%的人有使用AZA的经验（欧洲>北美，P = 0.0001）。69名受访者曾给孕妇开AZA，未观察到明显毒性。56.7%的受访者观察到AZA治疗后出现急性胰腺炎；提及25例恶性肿瘤（6例淋巴瘤、3例白血病、3例结肠癌、4例肾癌、9例其他）。140/291名受访者在急性溃疡性结肠炎中使用过CyA（北美45.1%，欧洲49.1%）；在所有受访者中，63.9%的人用CyA治疗的患者少于5例，36.1%的人治疗6 - 20例。29.5%的人认为CyA的治疗效果良好，58.6%的人认为可以接受但有复发，1分.3%的人认为效果不佳。47.8%的北美受访者和33.9%的欧洲受访者使用过MTX（无显著差异）。在大学医院和非大学医院工作的受访者的处方行为存在一些显著差异，特别是在参与临床试验方面。
在IBD的免疫抑制治疗方面有相当多的经验；然而，北美和欧洲在免疫抑制剂的选择上存在不同的处方行为。这些IOIBD的研究结果可能有助于胃肠病学家和其他专家更好地了解IBD中免疫抑制剂的日常使用情况。
