Fernández-Bañares F, Bertrán X, Esteve-Comas M, Cabré E, Menacho M, Humbert P, Planas R, Gassull M A
Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain.
Am J Gastroenterol. 1996 Dec;91(12):2498-9.
BACKGROUND/AIM: Therapeutic regimens with intravenous (i.v.) cyclosporine followed by oral cyclosporine maintenance therapy reduce the need for immediate surgery in steroid-refractory severe ulcerative colitis, but the short-term colectomy rate is still as high as 70%. We report our experience with long-term azathioprine maintenance therapy in a small series of ulcerative colitis patients with i.v. cyclosporine-induced remission.
Twelve of thirteen patients with severe ulcerative colitis refractory to i.v. prednisone (1 mg/kg/day for at least 10 days) went into remission after adding i.v. cyclosporine (4 mg/kg/day) and are the subjects of this report. After a discouraging initial experience with oral cyclosporine plus mesalazine as maintenance therapy in the first four patients, we treated the following patients with azathioprine plus mesalazine starting immediately after response to i.v. cyclosporine was obtained. Overall, only 1 of 10 patients treated with azathioprine relapsed after a mean follow-up of 16.3 months (range: 6-48). Moreover, this relapse probably occurred when the drug was still not therapeutically active because, after reinducing remission with oral prednisone, the patient remained symptomless on azathioprine. Steroids could be discontinued in all patients.
The relapse rate on maintenance therapy with azathioprine (10%) is a figure considerably lower than that previously reported with oral cyclosporine. This promising experience should be confirmed in randomized controlled trials.
背景/目的：静脉注射环孢素后序贯口服环孢素维持治疗方案可减少激素难治性重度溃疡性结肠炎患者急诊手术的需求，但短期结肠切除率仍高达70%。我们报告了一小系列静脉注射环孢素诱导缓解的溃疡性结肠炎患者长期使用硫唑嘌呤维持治疗的经验。
13例对静脉注射泼尼松（1mg/kg/天，至少10天）难治的重度溃疡性结肠炎患者中，12例在加用静脉注射环孢素（4mg/kg/天）后缓解，成为本报告的研究对象。在前4例患者中，口服环孢素加美沙拉嗪作为维持治疗的初始经验令人沮丧，之后我们在静脉注射环孢素起效后立即用硫唑嘌呤加美沙拉嗪治疗后续患者。总体而言，10例接受硫唑嘌呤治疗的患者中，平均随访16.3个月（范围：6 - 48个月）后只有1例复发。此外，这次复发可能发生在药物仍未发挥治疗作用时，因为在用口服泼尼松再次诱导缓解后，该患者在使用硫唑嘌呤时仍无症状。所有患者均可停用激素。
硫唑嘌呤维持治疗的复发率（10%）远低于先前报道的口服环孢素复发率。这一有前景的经验应在随机对照试验中得到证实。
