Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.
Aliment Pharmacol Ther. 2011 Feb;33(4):417-27. doi: 10.1111/j.1365-2036.2010.04541.x. Epub 2010 Dec 8.
Up to one-third of patients with inflammatory bowel disease (IBD) do not respond to, or are intolerant of conventional immunosuppressive drugs. Although biological agents are alternative treatments, they may not be suitable or available to some patients.
To review the evidence for use of nonbiological drugs in the treatment of patients with IBD refractory to corticosteroids or thiopurines.
A literature search was performed using PubMed for English language publications with predetermined search criteria to identify relevant studies.
Published evidence from uncontrolled series and controlled clinical trials has been used to produce a practical approach relevant to clinical practice which incorporates the indication, optimal dose, and side effects of various therapies including tacrolimus, methotrexate, thalidomide, tioguanine, mycophenolate mofotil, leucocyte apheresis, nutritional therapy, antibiotics, probiotics, allopurinol, rectal acetarsol and ciclosporin in the treatment of patients with refractory ulcerative colitis and Crohn's disease. Approaches to optimise thiopurine efficacy are also discussed.
Patients with IBD refractory to corticosteroids or thiopurines may respond to alternative anti-inflammatory chemical molecules, but the evidence base for many of these alternatives is limited and further trials are needed.
多达三分之一的炎症性肠病（IBD）患者对常规免疫抑制剂药物无反应或不耐受。尽管生物制剂是替代治疗方法，但对某些患者可能不适用或无法使用。
综述治疗对皮质类固醇或巯嘌呤类药物难治的 IBD 患者的非生物药物的证据。
使用 PubMed 进行了英语文献的检索，使用预定的检索标准来确定相关研究。
已使用来自非对照系列和对照临床试验的已发表证据，制定出一种与临床实践相关的实用方法，其中纳入了各种疗法的适应证、最佳剂量和副作用，包括他克莫司、甲氨蝶呤、沙利度胺、硫鸟嘌呤、霉酚酸酯、白细胞吸附、营养治疗、抗生素、益生菌、别嘌呤醇、直肠乙酰水杨酸和环孢素，用于治疗难治性溃疡性结肠炎和克罗恩病患者。还讨论了优化巯嘌呤疗效的方法。
对皮质类固醇或巯嘌呤类药物难治的 IBD 患者可能对其他抗炎化学分子有反应，但许多这些替代药物的证据基础有限，需要进一步的试验。
