Pedersen Natalia, Thielsen Peter, Martinsen Lars, Bennedsen Mette, Haaber Anne, Langholz Ebbe, Végh Zsuzsanna, Duricova Dana, Jess Tine, Bell Sally, Burisch Johan, Munkholm Pia
*Gastroenterology Unit, Herlev University Hospital, Copenhagen, Denmark; †Department of Gastroenterology, Nykoebing Falster Hospital, Nykoebing Falster, Denmark; ‡Department of Gastroenterology, Nordsjaellands Hospital, Frederikssund, Denmark; §Department of Gastroenterology, Gentofte Hospital, Gentofte, Denmark; ‖IBD Clinical and Research Center, ISCARE a. s., Charles University, Prague, Czech Republic; ¶Department of Epidemiology Research, States Serum Institute, Copenhagen, Denmark; and **Department of Gastroenterology, St. Vincent's University Hospital, Melbourne, Australia.
Inflamm Bowel Dis. 2014 Dec;20(12):2276-85. doi: 10.1097/MIB.0000000000000199.
To individualize treatment with mesalazine for ulcerative colitis relapses through a self-managed, web-based solution to optimize the short-term disease course.
Prospective, open-label, web-guided study with 3 months mesalazine therapy among patients with mild-to-moderate ulcerative colitis. Once a week, patients completed the simple clinical colitis activity index (SCCAI) and registered fecal calprotectin (FC) on the web application: www.meza.constant-care.dk. SCCAI and FC were summed and resulted in a total inflammatory burden score (TIBS). Deep remission was defined as SCCAI ≤1; FC = 0, and TIBS ≤1.
A total of 95 patients (62% females; median age 45 yr) were included in the study and allocated 4.8 g mesalazine per day. Of these, 82 (86%) patients were adherent to web therapy, completing 3 months of web-guided mesalazine therapy. Of the 82 adherent patients, 72 (88%) continued mesalazine and 10 (12%) needed rescue therapy. From weeks 0 to 12, patients had experienced a significant reduction in mean SCCAI (4.6 versus 1.6, P < 0.001), mean FC (437 versus 195, P < 0.001), and mean TIBS (6.7 versus 2.4, P < 0.001). Based on TIBS values (≤1), the dose of mesalazine was reduced to 2.4 g in 25% of patients at week 3 in 50% of subjects at week 5 and in 88% of patients at week 12.
Web-guided therapy with mesalazine in mild-to-moderate ulcerative colitis helps to individualize the dose and improve adherence to therapy. The study confirms mesalazine efficacy in mild-to-moderate UC, significantly improving TIBS values in majority of the patients.
通过基于网络的自我管理解决方案，使美沙拉嗪治疗溃疡性结肠炎复发的方案个体化，以优化短期病程。
对轻度至中度溃疡性结肠炎患者进行前瞻性、开放标签、网络指导的研究，给予3个月的美沙拉嗪治疗。患者每周一次在网络应用程序（www.meza.constant-care.dk）上完成简单临床结肠炎活动指数（SCCAI）并记录粪便钙卫蛋白（FC）。将SCCAI和FC相加得出总炎症负担评分（TIBS）。深度缓解定义为SCCAI≤1；FC = 0，且TIBS≤1。
共有95例患者（62%为女性；中位年龄45岁）纳入研究，每天给予4.8克美沙拉嗪。其中，82例（86%）患者坚持网络治疗，完成了3个月的网络指导美沙拉嗪治疗。在这82例坚持治疗的患者中，72例（88%）继续使用美沙拉嗪，10例（12%）需要救援治疗。从第0周开始至第12周，患者的平均SCCAI（4.6对1.6，P < 0.001）、平均FC（437对195，P < 0.001）和平均TIBS（6.7对2.4，P < 0.001）均显著降低。基于TIBS值（≤1），25%的患者在第3周时美沙拉嗪剂量减至2.4克，50%的受试者在第5周时减至该剂量，88%的患者在第12周时减至该剂量。
在轻度至中度溃疡性结肠炎中，网络指导的美沙拉嗪治疗有助于使剂量个体化并提高治疗依从性。该研究证实了美沙拉嗪在轻度至中度溃疡性结肠炎中的疗效，显著改善了大多数患者的TIBS值。
