IBD Unit, St Mark's Hospital, Harrow, London HA1 3UJ, UK.
J Crohns Colitis. 2013 Dec;7(11):e516-21. doi: 10.1016/j.crohns.2013.03.008. Epub 2013 Apr 25.
The medical management of refractory ulcerative colitis (UC) remains a significant challenge. Two randomised controlled studies have demonstrated tacrolimus therapy is effective for the induction of remission of moderate to severe UC. However, the long term outcomes of UC patients treated with tacrolimus as maintenance therapy are not certain.
This study aims to assess the efficacy of tacrolimus maintenance therapy for refractory UC.
A retrospective review of patients with UC treated with tacrolimus at two London tertiary centres was performed. Clinical outcomes were assessed at six months, at the end of tacrolimus treatment, or at the last follow-up for patients continuing tacrolimus treatment. Modified Truelove-Witts score (mTW) and Mayo endoscopy subscores were calculated.
25 patients with UC, treated with oral tacrolimus between 2005 and 2011, were identified. The median duration of tacrolimus treatment was 9 months (IQR 3.7-18.2 months). The median duration of follow-up was 27 months (range 3-66 months). At six months thirteen (52%) patients had achieved and maintained clinical response and eleven (44%) were in clinical remission. The mean mTW score decreased from 10+/-0.5 before therapy, to 5.8+/-0.8 (p≤0.001 95% CI 2.7-5.8) at cessation of treatment or last follow-up. Mayo endoscopy subscore decreased from 2.6+/-0.1 to 1.2+/-0.2 (p≤0.001 mean reduction 1.4, 95% CI 0.8-1.9). Eight patients (32%) subsequently underwent a colectomy within a mean time of 17 months (range 2-45 months).
Tacrolimus is effective for the maintenance of refractory UC and can deliver sustained improvement in mucosal inflammation.
溃疡性结肠炎（UC）的医学治疗仍然是一个重大挑战。两项随机对照研究表明，他克莫司治疗对中重度 UC 的缓解有效。然而，接受他克莫司治疗的 UC 患者的长期结果尚不确定。
本研究旨在评估他克莫司维持治疗对难治性 UC 的疗效。
对在伦敦两个三级中心接受他克莫司治疗的 UC 患者进行回顾性研究。在六个月时、他克莫司治疗结束时或继续接受他克莫司治疗的患者的最后一次随访时评估临床结局。计算改良 Truelove-Witts 评分（mTW）和 Mayo 内镜亚评分。
确定了 2005 年至 2011 年间接受口服他克莫司治疗的 25 例 UC 患者。他克莫司治疗的中位时间为 9 个月（IQR 3.7-18.2 个月）。中位随访时间为 27 个月（范围 3-66 个月）。在六个月时，十三名（52%）患者达到并维持临床缓解，十一名（44%）患者处于临床缓解。mTW 评分从治疗前的 10+/-0.5 均值下降到治疗结束或最后一次随访时的 5.8+/-0.8（p≤0.001 95%CI 2.7-5.8）。Mayo 内镜亚评分从 2.6+/-0.1 降至 1.2+/-0.2（p≤0.001 平均降低 1.4，95%CI 0.8-1.9）。八名患者（32%）随后在平均 17 个月（范围 2-45 个月）内接受了结肠切除术。
他克莫司对难治性 UC 的维持治疗有效，并能持续改善黏膜炎症。
