van Berge Henegouwen G P
Universitair Medisch Centrum Utrecht, afd. Maag-, Darm- en Leverziekten, CX Utrecht.
Ned Tijdschr Geneeskd. 2000 Sep 16;144(38):1844-5.
Very recently infliximab--a tumour necrosis factor blocking antibody--was registered as an important novel immunomodulating therapy for active Crohn's disease in the Netherlands. Although this treatment can have a very significant and sometimes dramatic effect (on remission induction), its longterm effects are still uncertain and the high cost is a major drawback. An expert committee of specialists in inflammatory bowel disease (IBD) in the Netherlands therefore produced a consensus report on specific treatment indications for its use. It is stated that only immunosuppressive-resistant patients or patients with incompatibilities and allergies to prednisone, azathioprine and methotrexate should be candidates, a second indication being patients with serious enterocutaneous fistulae not reacting to a full course of conventional therapy. Its use is not indicated in patients with stenosing disease. It is also stated that the effect of longterm repeated therapy in active Crohn's disease still has to be established. Since budget limitations for medications are a major disadvantage, the formation of expert committees (with an expert in the treatment of complicated inflammatory bowel disease) in each hospital should be stimulated to limit the treatment to only cases with real immunosuppressive-resistant disease.
最近，英夫利昔单抗（一种肿瘤坏死因子阻断抗体）在荷兰被注册为治疗活动性克罗恩病的一种重要新型免疫调节疗法。尽管这种治疗（在诱导缓解方面）可能有非常显著甚至有时是惊人的效果，但其长期效果仍不确定，且费用高昂是一个主要缺点。因此，荷兰炎症性肠病（IBD）专家委员会就其使用的具体治疗指征发布了一份共识报告。报告指出，只有对免疫抑制治疗耐药的患者，或对泼尼松、硫唑嘌呤和甲氨蝶呤有不耐受及过敏反应的患者才应成为使用该药物的候选者，第二个指征是患有严重肠皮肤瘘且对整个常规治疗疗程无反应的患者。狭窄性疾病患者不适用该药物。报告还指出，长期重复治疗对活动性克罗恩病的效果仍有待确定。由于药物预算限制是一个主要不利因素，应鼓励各医院成立专家委员会（由治疗复杂炎症性肠病的专家组成），以便将该治疗仅限于真正对免疫抑制治疗耐药的病例。
