Gonvers Jean-Jacques, Juillerat Pascal, Mottet Christian, Pittet Valérie, Felley Christian, Vader John-Paul, Michetti Pierre, Froehlich Florian
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Digestion. 2007;76(2):116-29. doi: 10.1159/000111026. Epub 2008 Feb 7.
The natural history of Crohn's disease is characterized by recurring flares alternating with periods of inactive disease and remission. This implies that most patients need to take medication for a large period of their life, mostly for maintenance of remission and, intermittently, additional therapy during a flare. Low-dose systemic corticosteroids are not effective in maintaining remission and should not be used for this indication. There is a trend towards a prolonged time to relapse in patients in remission who are treated with budenoside, a corticosteroid with high topical anti-inflammatory activity and low systemic activity. Azathioprine and 6-mercaptopurine are effective in maintaining remission. Maintenance benefits remain significant for patients who continued with the therapy for up to 5 years. Methotrexate has also been found to be effective in maintaining remission in Crohn's disease in patients who have responded acutely to methotrexate. Cyclosporine has not been found to be an effective maintenance agent. Only a few studies in small numbers of patients have been published on the use of tacrolimus. There is a lack of convincing evidence of efficacy of mycophenolate mofetil. The use of anti-TNF agents may change the future approach to maintenance therapy for Crohn's disease. Patients who responded clinically to infliximab, adalimumab and certolizumab have maintained their clinical response when receiving repeat infusions or subcutaneous injections, respectively. In patients refractory to other therapies, infliximab may be effective in maintaining remission.
克罗恩病的自然病史的特点是病情反复复发，与疾病静止期和缓解期交替出现。这意味着大多数患者在其一生中的大部分时间都需要服药，主要是为了维持缓解状态，并且在病情发作期间需要间歇性地进行额外治疗。低剂量全身性皮质类固醇在维持缓解方面无效，不应为此适应症使用。对于接受布地奈德治疗的缓解期患者，有复发时间延长的趋势，布地奈德是一种具有高局部抗炎活性和低全身活性的皮质类固醇。硫唑嘌呤和6-巯基嘌呤在维持缓解方面有效。对于持续接受该治疗长达5年的患者，维持治疗的益处仍然显著。甲氨蝶呤也已被发现对急性反应的克罗恩病患者维持缓解有效。环孢素尚未被发现是一种有效的维持治疗药物。关于他克莫司的使用，仅发表了少数针对少数患者的研究。缺乏令人信服的证据表明霉酚酸酯的疗效。抗TNF药物的使用可能会改变未来克罗恩病维持治疗的方法。对英夫利昔单抗、阿达木单抗和赛妥珠单抗有临床反应的患者，在分别接受重复输注或皮下注射时，维持了他们的临床反应。在对其他疗法难治的患者中，英夫利昔单抗可能对维持缓解有效。
