Department of Gastroenterology, Hepatology and Endocrinology, Robert-Bosch-Hospital, Stuttgart, Germany.
Aliment Pharmacol Ther. 2010 May;31(9):1036-41. doi: 10.1111/j.1365-2036.2010.04267.x. Epub 2010 Feb 18.
The calcineurin inhibitor tacrolimus and the anti-TNF-antibody infliximab are established options in steroid-refractory ulcerative colitis (UC).
To evaluate the efficacy of infliximab-salvage therapy in patients with refractory UC failing to respond to tacrolimus.
Twenty-four patients were enrolled in this evaluation. Reasons for tacrolimus therapy were steroid-refractory disease in 19 patients and steroid-dependency in five patients. All patients receiving infliximab had tacrolimus-refractory active disease (Lichtiger score >10) and were treated with 5 mg/kg at weeks 0, 2 and 6 and every 8 weeks thereafter, if tolerated.
Six of 24 patients (25%) achieved remission following infliximab infusion and four of 24 (17%) had an initial response only, but underwent proctocolectomy later because of loss of response (3) or development of a delayed hypersensitivity reaction (1). Fourteen patients (58%) completely failed to respond with 10 undergoing colectomy. Eight patients experienced side effects under infliximab, including two infectious complications (herpes zoster and herpes pneumonia).
Infliximab offers a therapeutic option as rescue therapy in about a quarter of patients with active UC after failing to respond to tacrolimus. This benefit has to be weighed against the risks of infectious complications.
钙调磷酸酶抑制剂他克莫司和抗 TNF 抗体英夫利昔单抗是治疗类固醇难治性溃疡性结肠炎（UC）的标准选择。
评估英夫利昔单抗补救疗法在对他克莫司无反应的难治性 UC 患者中的疗效。
本评估纳入 24 例患者。19 例患者因类固醇难治性疾病而接受他克莫司治疗，5 例患者因类固醇依赖性疾病而接受他克莫司治疗。所有接受英夫利昔单抗治疗的患者均患有他克莫司难治性活动期疾病（Lichtiger 评分>10），如果耐受，在第 0、2 和 6 周给予 5mg/kg，此后每 8 周给予一次。
24 例患者中有 6 例（25%）在接受英夫利昔单抗输注后缓解，24 例中有 4 例（17%）仅初始反应，但因失应答（3 例）或迟发性超敏反应（1 例）而随后行结肠切除术。14 例患者（58%）完全无应答，其中 10 例行结肠切除术。8 例患者在接受英夫利昔单抗治疗时出现副作用，包括 2 例感染性并发症（带状疱疹和疱疹性肺炎）。
在对他克莫司无反应的活动期 UC 患者中，英夫利昔单抗作为补救治疗提供了一种治疗选择，约四分之一的患者有效。但需要权衡感染性并发症的风险。
