van Deventer S J, Tytgat G N
Academisch Medisch Centrum/Universiteit van Amsterdam.
Ned Tijdschr Geneeskd. 1998 May 23;142(21):1191-5.
The medical management of Crohn's disease has changed in recent years, but the mainstay of treatment is still prednisone. A substantial fraction of steroid-treated patients are refractory to therapy and addition of azathioprine or methotrexate has a corticosteroid-sparing effect and increases duration of remission. Controlled ileal release budesonide (9 mg daily) induces clinical remission in 60-70% of patients with Crohn's ileitis or right-sided colitis, and continued budesonide treatment has a finite effect on the duration of remission. The efficacy of mesalazine in active Crohn's disease is limited and high doses are required (4000 mg/day). The role of mesalazine in Crohn's disease in remission is disputed, and there is no evidence of a corticosteroid-sparing effect.
近年来，克罗恩病的药物治疗有所变化，但治疗的主要药物仍是泼尼松。相当一部分接受类固醇治疗的患者对治疗无效，添加硫唑嘌呤或甲氨蝶呤具有糖皮质激素节省效应，并可延长缓解期。控释型回肠布地奈德（每日9毫克）可使60%至70%的克罗恩病回肠炎或右侧结肠炎患者实现临床缓解，持续使用布地奈德治疗对缓解期的延长作用有限。美沙拉嗪在活动性克罗恩病中的疗效有限，需要高剂量使用（每日4000毫克）。美沙拉嗪在克罗恩病缓解期的作用存在争议，且没有证据表明其具有糖皮质激素节省效应。
