Cortes Xavier, Borrás-Blasco Joaquín, Fernendez Sergio, Moreno Marta, Rodríguez Josefa, Molés Jose Ramón, Casterá Elvira
Int J Clin Pharmacol Ther. 2016 Feb;54(2):125-8. doi: 10.5414/CP202487.
To report of a case successful use of infliximab (IFX) and tacrolimus (TAC) in a patient with ulcerative colitis (UC).
A 22-year-old woman diagnosed with UC started treatment with azathioprine 2.5 mg/kg. After 3 years of therapy, she developed a severe relapse. A colonoscopy was performed showing diffuse continuous mucosal disease and multiple erosions (< 5 mm) with no signs of spontaneous bleeding. Treatment with IFX 5 mg/kg at weeks 0, 2, and 6 was started. After IFX induction, she remained with symptoms: six stools per day, as well as presenting bloody diarrhea, tenesmus, and no abdominal pain. An IFX dose intensification of 5 mg/kg every 6 weeks was prescribed. After 6 months of azathioprine plus IFX therapy, patient's clinical condition was improved: 3 - 4 stools per day, 20% of bloody diarrhea, tenesmus, and no abdominal pain. Her Mayo endoscopic subscore was 6.3 months later, and a severe relapse of ulcerative colitis was presented. The patient refused a surgical treatment. Azathioprine 2.5 mg/kg/day was suspended and TAC 0.2 mg/kg/day (12 mg/day) as a compassionate use was added to IFX dose intensification of 10 mg/kg every 8 weeks and mesalamine 800 mg 3 times daily. After the first month of combined therapy, the patient's clinical condition improved with no bloody stools and abdominal pain. After 6 months of combination therapy, the patient was in remission, with two stools per day, no tenesmus and no abdominal pain. Due to the patient's clinical remission, IFX was suspended. Tacrolimus was continued on 10 mg/day. After 6 months of TAC monotherapy, the patient continued without symptoms (1 - 2 normal stools per day).
Based on our case, the combination therapy of IFX and TAC could be selected as an effective approach for the patients with UC refractory to IFX dose intensification plus AZA. However, further studies need to be performed to evaluate the efficacy of this combination therapy.
报告1例成功使用英夫利昔单抗（IFX）和他克莫司（TAC）治疗溃疡性结肠炎（UC）患者的病例。
一名22岁诊断为UC的女性患者开始使用硫唑嘌呤2.5mg/kg进行治疗。经过3年治疗后，她出现了严重复发。进行结肠镜检查显示弥漫性连续性黏膜病变和多处糜烂（<5mm），无自发性出血迹象。在第0、2和6周开始使用IFX 5mg/kg进行治疗。IFX诱导治疗后，她仍有症状：每天排便6次，伴有血性腹泻、里急后重，无腹痛。规定每6周将IFX剂量增加5mg/kg。硫唑嘌呤加IFX治疗6个月后，患者临床状况改善：每天排便3 - 4次，20%为血性腹泻，有里急后重，无腹痛。6.3个月后她的梅奥内镜亚评分为6，出现了溃疡性结肠炎的严重复发。患者拒绝手术治疗。停用硫唑嘌呤2.5mg/kg/天，作为同情用药添加TAC 0.2mg/kg/天（12mg/天），同时每8周将IFX剂量增加至10mg/kg，并每天3次服用美沙拉嗪800mg。联合治疗第一个月后，患者临床状况改善，无血性便和腹痛。联合治疗6个月后，患者处于缓解期，每天排便2次，无里急后重和腹痛。由于患者临床缓解，停用IFX。继续使用他克莫司10mg/天。TAC单药治疗6个月后，患者持续无症状（每天1 - 2次正常排便）。
基于我们的病例，IFX和TAC联合治疗可作为对IFX剂量增加加用AZA治疗无效的UC患者的一种有效方法。然而，需要进一步研究来评估这种联合治疗的疗效。
