Hoentjen Frank, Sakuraba Atsushi, Hanauer Stephen
Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 4076, Chicago, IL 60637, USA.
Curr Gastroenterol Rep. 2011 Oct;13(5):475-85. doi: 10.1007/s11894-011-0216-6.
The treatment options for inflammatory bowel disease have expanded with the introduction of biological therapies. Recently published controlled clinical trials were searched and those that impact the clinical management of ulcerative colitis (UC) are discussed in this review. In the management of mild to moderate UC, mesalamine still remains the first choice of drug. The newly developed once daily formulations have shown equal efficacy to divided doses and possibly portend better compliance owing to a simplified regimen. In outpatients with moderate to severe UC, recent data indicate that infliximab induced and maintained remission leads to decreased colectomy rates and fewer hospitalizations. An alternative anti-tumor necrosis factor (TNF) agent, adalimumab, was also recently shown to be effective for induction of remission in moderate to severe UC. The use of immunosuppressives, such as azathioprine and mercaptopurine, is associated with decreased colectomy rates and thioguanine was shown to be effective in maintaining clinical remission in those who are intolerant to azathioprine/mercaptopurine. In hospitalized patients with steroid resistant severe UC, infliximab and tacrolimus may be alternatives to cyclosporine in those who are otherwise candidates for colectomy. Adequate long-term maintenance therapy with immunosuppressives or anti-TNF therapy is required after rescue therapy for a sustained benefit. Future research is needed to position the available anti-TNF agents and combined immunosuppressive therapy in the treatment of UC to achieve and maintain steroid free remission.
随着生物疗法的引入，炎症性肠病的治疗选择有所增加。检索了最近发表的对照临床试验，并在本综述中讨论了那些对溃疡性结肠炎（UC）临床管理有影响的试验。在轻度至中度UC的管理中，美沙拉嗪仍然是首选药物。新开发的每日一次剂型已显示出与分剂量相同的疗效，并且由于简化的治疗方案，可能预示着更好的依从性。在中度至重度UC的门诊患者中，最近的数据表明，英夫利昔单抗诱导并维持缓解可降低结肠切除术率并减少住院次数。另一种抗肿瘤坏死因子（TNF）药物阿达木单抗最近也被证明对中度至重度UC的缓解诱导有效。使用免疫抑制剂，如硫唑嘌呤和巯嘌呤，与结肠切除术率降低相关，并且硫鸟嘌呤被证明对那些不耐受硫唑嘌呤/巯嘌呤的患者维持临床缓解有效。在患有类固醇抵抗性重度UC的住院患者中，对于那些原本是结肠切除术候选者的患者，英夫利昔单抗和他克莫司可能是环孢素的替代药物。抢救治疗后需要使用免疫抑制剂或抗TNF治疗进行充分的长期维持治疗，以获得持续益处。未来需要开展研究，以确定可用的抗TNF药物和联合免疫抑制疗法在UC治疗中的地位，以实现并维持无类固醇缓解。
