Yoshino Takuya, Sono Makoto, Yazumi Shujiro
Division of Gastroenterology and Hepatology , Digestive Disease Center, Kitano Hospital , Osaka , Japan.
BMJ Open Gastroenterol. 2016 Aug 16;3(1):e000103. doi: 10.1136/bmjgast-2016-000103. eCollection 2016.
Patients with refractory-ulcerative colitis (UC) require therapy escalation. Sulfasalazine (SASP) could deliver a high concentration of 5-aminosalicylic acid to the colon. The usefulness of SASP for refractory-UC patients, however, is unclear.
The aim was to evaluate the usefulness of SASP for refractory-UC patients.
We retrospectively analysed 36 (11.4%) of 316 patients with refractory-UC who had been treated with SASP. Clinical and endoscopic activities were evaluated with Lichtiger index and Mayo score, respectively. We analysed the induction-remission rate, predictive factors for the efficacy of SASP, and adverse events.
Of 36 refractory-UC patients, 14 (38.9%) were treated with concomitant mesalazine enemas, 10 (27.8%) with azathiopurine, 4 (11.1%) with tacrolimus and 6 (16.7%) with an antitumour necrosis factor-α agent. After initiating SASP treatment, 25 patients (69.4%) achieved clinical remission. In 9 (64.3%) of 14 patients with UC treated with mesalazine enemas, mesalazine enemas could be discontinued with SASP. In all patients treated with tacrolimus, tacrolimus could be discontinued with SASP. Clinical activity score upon the initiation of SASP was significantly lower (p=0.024) and the number of patients treated with thiopurine was significantly higher (p=0.016) in the clinical remission group than in the non-clinical remission group. These factors might be predictive for the efficacy of SASP, although multivariate analysis demonstrated no statistically significant effect. Adverse events occurred in 7 patients (19.4%), and reduction or discontinuation of SASP led to improvement.
SASP appears to be more effective for refractory-UC patients with low clinical-activity and/or thiopurine-use.
UMIN000021615; Results.
难治性溃疡性结肠炎（UC）患者需要加强治疗。柳氮磺胺吡啶（SASP）可将高浓度的5-氨基水杨酸输送至结肠。然而，SASP对难治性UC患者的有效性尚不清楚。
评估SASP对难治性UC患者的有效性。
我们回顾性分析了316例接受SASP治疗的难治性UC患者中的36例（11.4%）。分别采用Lichtiger指数和梅奥评分评估临床和内镜活动度。我们分析了诱导缓解率、SASP疗效的预测因素及不良事件。
36例难治性UC患者中，14例（38.9%）同时接受美沙拉嗪灌肠治疗，10例（27.8%）接受硫唑嘌呤治疗，4例（11.1%）接受他克莫司治疗，6例（16.7%）接受抗肿瘤坏死因子-α制剂治疗。开始SASP治疗后，25例患者（69.4%）实现临床缓解。在14例接受美沙拉嗪灌肠治疗的UC患者中，9例（64.3%）在使用SASP后可停用美沙拉嗪灌肠。在所有接受他克莫司治疗的患者中，使用SASP后均可停用他克莫司。临床缓解组开始使用SASP时的临床活动评分显著更低（p=0.024），接受硫嘌呤治疗的患者数量显著更多（p=0.016）。尽管多因素分析显示无统计学显著影响，但这些因素可能是SASP疗效的预测因素。7例患者（19.4%）发生不良事件，减少或停用SASP后症状改善。
SASP似乎对临床活动度低和/或使用硫嘌呤的难治性UC患者更有效。
UMIN000021615；结果。
