Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
Clin J Gastroenterol. 2022 Oct;15(5):924-928. doi: 10.1007/s12328-022-01653-1. Epub 2022 Jul 14.
Abatacept (ABT) is a recombinant fusion protein consisting of the Fc domain fragment of human IgG1 and the extracellular domain of human cytotoxic T lymphocyte antigen-4 (CTLA-4). The function of ABT is similar to that of CTLA-4, which selectively regulates T-cell activation by inhibiting the co-stimulation of CD80/CD86 on antigen-presenting cells and CD28 on T lymphocytes. ABT is used for the treatment of rheumatoid arthritis (RA) and juvenile idiopathic arthritis. We report two cases of ulcerative colitis (UC) that developed while using ABT. Case 1 is of a 58-year-old man who developed diarrhea and hematochezia 2 months after starting ABT therapy for RA. Case 2 is of a 66-year-old man who experienced hematochezia 15 months after starting ABT therapy for RA. In both cases, no obvious gastrointestinal symptoms were observed before ABT therapy was initiated. Colonoscopy after disease onset showed UC findings in both cases. The patients' condition improved following ABT withdrawal and treatment for UC. Several cases of UC development during ABT therapy have been reported. The complication of UC should be considered when diarrhea and hematochezia are observed in patients with RA being treated with CTLA-4Ig agents.
阿巴西普（ABT）是一种由人 IgG1 的 Fc 结构域片段与人细胞毒性 T 淋巴细胞抗原 4（CTLA-4）的细胞外结构域组成的重组融合蛋白。ABT 的功能与 CTLA-4 相似，通过抑制抗原呈递细胞上的 CD80/CD86 与 T 淋巴细胞上的 CD28 的共刺激，选择性调节 T 细胞的激活。ABT 用于治疗类风湿关节炎（RA）和青少年特发性关节炎。我们报告了两例使用 ABT 时发生的溃疡性结肠炎（UC）病例。病例 1 为 58 岁男性，在开始使用 ABT 治疗 RA 后 2 个月出现腹泻和血便。病例 2 为 66 岁男性，在开始使用 ABT 治疗 RA 后 15 个月出现血便。在这两种情况下，在开始 ABT 治疗之前，均未观察到明显的胃肠道症状。发病后结肠镜检查显示两例均为 UC 表现。ABT 停药和 UC 治疗后，患者病情改善。已有几例在使用 ABT 治疗期间发生 UC 的报道。当用 CTLA-4Ig 制剂治疗的 RA 患者出现腹泻和血便时，应考虑 UC 的并发症。
