Ardizzone S, Bianchi Porro G
Gastrointestinal Unit, L. Sacco University Hospital, Milan, Italy.
Drugs. 1998 Apr;55(4):519-42. doi: 10.2165/00003495-199855040-00004.
This article reviews the role of corticosteroids, sulfasalazine and mesalazine (5-aminosalicylic acid, mesalamine), immunosuppressive agents and alternative novel drugs for the treatment of distal ulcerative colitis. Short cycles of traditional, rectally administered corticosteroids (methylprednisolone, betamethasone, hydrocortisone) are effective for the treatment of mild to moderately active distal ulcerative colitis. In this context, their systemic administration is limited to patients who are refractory to either oral 5-amino-salicylates, topical mesalazine or topical corticosteroids. Of no value in maintaining remission, the long term use of either or topical corticosteroids may be hazardous. A new class of topically acting corticosteroids [budesonide, fluticasone, beclomethasone dipropionate, prednisolone-21-methasulphobenzoate, tixocortol (tixocortol pivalate)] represents a valid alternative for the treatment of active ulcerative colitis, and may be useful in the treatment of refractory distal ulcerative colitis. Although there is controversy concerning dosage or duration of therapy, oral and topical mesalazine is effective in the treatment of mild to moderately active distal ulcerative colitis. Sulfasalazine and mesalazine remain the first-choice drugs for the maintenance therapy of distal ulcerative colitis. Evidence exists showing a trend to a higher remission rate with higher doses of oral mesalazine. Topical mesalazine (suppositories or enemas) also is effective in maintenance treatment. For patients with chronically active or corticosteroid-dependent disease, azathioprine and mercaptopurine are effective in reducing either the need for corticosteroids or clinical relapses. Moreover, they are effective for long term maintenance remission. Cyclosporin may be useful in inducing remission in patients with acutely severe disease who do not achieve remission with an intensive intravenous regimen. Existing data suggest that azathioprine and mercaptopurine may be effective in prolonging remission in these patients. The role of alternative drugs for the treatment of distal ulcerative colitis and its different forms is reviewed. In particular data are reported concerning the effectiveness of 5-lipoxygenase inhibitors, topical use of short chain fatty acids, nicotine, local anaesthetics, bismuth subsalicylate enema, sucralfate, clonidine, free radical scavengers, heparin and hydroxychloroquine.
本文综述了皮质类固醇、柳氮磺胺吡啶和美沙拉嗪（5-氨基水杨酸）、免疫抑制剂及其他新型药物在治疗远端溃疡性结肠炎中的作用。传统的经直肠给药的皮质类固醇（甲泼尼龙、倍他米松、氢化可的松）短期疗程对治疗轻至中度活动性远端溃疡性结肠炎有效。在这种情况下，全身给药仅限于对口服5-氨基水杨酸、局部用美沙拉嗪或局部用皮质类固醇治疗无效的患者。皮质类固醇无论是全身用药还是局部用药，长期使用对维持缓解均无价值，且可能有风险。一类新型的局部作用皮质类固醇[布地奈德、氟替卡松、二丙酸倍氯米松、泼尼松龙-21-甲磺苯酸盐、替可的松（替可的松新戊酸酯）]是治疗活动性溃疡性结肠炎的有效替代药物，可能对治疗难治性远端溃疡性结肠炎有用。尽管在治疗剂量或疗程方面存在争议，但口服和美沙拉嗪局部用药对治疗轻至中度活动性远端溃疡性结肠炎有效。柳氮磺胺吡啶和美沙拉嗪仍是远端溃疡性结肠炎维持治疗的首选药物。有证据表明，口服美沙拉嗪剂量越高，缓解率有升高趋势。局部用美沙拉嗪（栓剂或灌肠剂）在维持治疗中也有效。对于慢性活动性或皮质类固醇依赖型疾病患者，硫唑嘌呤和巯嘌呤可有效减少对皮质类固醇的需求或临床复发。此外，它们对长期维持缓解有效。环孢素可能有助于诱导急性重症患者缓解，这些患者采用强化静脉治疗方案未达到缓解。现有数据表明，硫唑嘌呤和巯嘌呤可能对延长这些患者的缓解期有效。本文综述了其他药物在治疗远端溃疡性结肠炎及其不同形式中的作用。特别报道了有关5-脂氧合酶抑制剂、短链脂肪酸局部应用、尼古丁、局部麻醉药、次水杨酸铋灌肠剂、硫糖铝、可乐定、自由基清除剂、肝素和羟氯喹有效性的数据。
