Egan L J, Sandborn W J, Tremaine W J
Inflammatory Bowel Disease Clinic, Division of Gastroenterology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Am J Gastroenterol. 1998 Mar;93(3):442-8. doi: 10.1111/j.1572-0241.1998.00442.x.
To determine outcome following treatment of refractory Crohn's disease with intravenous (i.v.) cyclosporine (CYA).
The medical records of 18 patients with refractory Crohn's disease treated with i.v. CYA were reviewed. Nine patients had refractory inflammatory Crohn's disease and nine patients had complex fistulizing Crohn's disease. All patients were initially treated with i.v. CYA (4 mg/kg/day). Patients who responded were converted to standard oral CYA. Patient outcomes were classified as complete response, partial response, or nonresponse.
Four of nine patients with severe inflammatory Crohn's disease and seven of nine patients with fistulizing Crohn's disease had a partial response to i.v. CYA. Four of four responding patients in the inflammatory group and four of six responding patients in the fistulizing group (plus one initial nonresponder) maintained or improved their response during oral CYA therapy. After discontinuing oral CYA, all four patients in the inflammatory group and five of seven patients in the fistulizing group relapsed despite 1-17 wk of concomitant treatment with azathioprine or 6-mercaptopurine (AZA/6MP). Two patients who received overlapping CYA and AZA/6MP for 17 and 23 wk maintained long-term responses. CYA toxicity was minimal: reversible nephrotoxicity (n = 2), headache (n = 2), oral candidiasis (n = 1), paresthesia (n = 2).
I.v. CYA appears to benefit both refractory inflammatory and fistulizing Crohn's disease. Most patients who respond to i.v. CYA will maintain their response during oral CYA therapy. However, the majority of these patients relapse when oral CYA is discontinued, probably because of inadequate duration of overlap with the slow acting maintenance drugs, AZA/6MP.
确定静脉注射环孢素（CYA）治疗难治性克罗恩病后的疗效。
回顾了18例接受静脉注射CYA治疗的难治性克罗恩病患者的病历。9例患者为难治性炎症性克罗恩病，9例患者为复杂性瘘管性克罗恩病。所有患者最初均接受静脉注射CYA（4mg/kg/天）治疗。有反应的患者转为标准口服CYA治疗。患者结局分为完全缓解、部分缓解或无反应。
9例严重炎症性克罗恩病患者中有4例，9例瘘管性克罗恩病患者中有7例对静脉注射CYA有部分反应。炎症组4例有反应的患者和瘘管组6例有反应的患者中的4例（加1例最初无反应者）在口服CYA治疗期间维持或改善了反应。停用口服CYA后，炎症组的所有4例患者和瘘管组的7例患者中的5例复发，尽管同时接受了1至17周的硫唑嘌呤或6-巯基嘌呤（AZA/6MP）治疗。2例接受CYA与AZA/6MP重叠治疗17周和23周的患者维持了长期反应。CYA的毒性极小：可逆性肾毒性（n = 2）、头痛（n = 2）、口腔念珠菌病（n = 1）、感觉异常（n = 2）。
静脉注射CYA似乎对难治性炎症性和瘘管性克罗恩病均有益。大多数对静脉注射CYA有反应的患者在口服CYA治疗期间将维持其反应。然而，这些患者中的大多数在停用口服CYA后复发，可能是因为与慢效维持药物AZA/6MP重叠治疗的时间不足。
