Ganzleben Ingo, Geppert Carol, Osaba Lourdes, Hirschmann Simon, Nägel Andreas, Glück Christian, Hoffman Arthur, Rath Timo, Nagore Daniel, Neurath Markus F, Atreya Raja
Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
Department of Pathology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
Therap Adv Gastroenterol. 2020 Oct 10;13:1756284820954112. doi: 10.1177/1756284820954112. eCollection 2020.
The therapeutic management of patients with severe steroid-refractory ulcerative colitis still represents a critical clinical challenge. In this setting, cyclosporin is an effective and rapidly acting induction treatment that is applied in combination with maintenance therapeutic agents like thiopurines or vedolizumab. Here, we present the case of a 33-year-old ulcerative colitis patient with severe steroid-refractory ulcerative colitis who refused surgical intervention and previously demonstrated no long-term benefit to anti-TNF antibody, vedolizumab, cyclosporin, thiopurines or tofacitinib treatment. Intravenous cyclosporin therapy was re-initiated in the patient and, after signs of clinical response, therapy with ustekinumab was additionally applied. After 11 weeks of well tolerated cyclosporin and ustekinumab combination therapy, cyclosporin was discontinued upon clinical and endoscopic remission. Subsequently, ustekinumab treatment has been effective in maintaining remission during the follow-up period of 195 days.
重度激素难治性溃疡性结肠炎患者的治疗管理仍然是一项严峻的临床挑战。在这种情况下，环孢素是一种有效且起效迅速的诱导治疗药物，可与硫唑嘌呤或维多珠单抗等维持治疗药物联合使用。在此，我们报告一例33岁的重度激素难治性溃疡性结肠炎患者，该患者拒绝手术干预，且先前使用抗TNF抗体、维多珠单抗、环孢素、硫唑嘌呤或托法替布治疗均未显示出长期疗效。该患者重新开始静脉注射环孢素治疗，在出现临床反应迹象后，加用优特克单抗治疗。在11周耐受性良好的环孢素和优特克单抗联合治疗后，临床和内镜检查缓解后停用环孢素。随后，在195天的随访期内，优特克单抗治疗有效地维持了缓解状态。
