胃と腸46巻13号

2011年12月発行

今月の主題 難治性潰瘍性大腸炎─診療・治療の新たな展開 主題

難治性潰瘍性大腸炎に対する最新の治療法―本邦と欧米の現況

著者： 平田一郎¹

所属機関： ¹藤田保健衛生大学消化管内科

ページ範囲：P.1913 - P.1920

要旨　本邦では，難治性潰瘍性大腸炎（UC）の急性期寛解導入治療としてシクロスポリン持続静注，タクロリムス経口投与，インフリキシマブ（IFX）点滴静注，血球成分除去療法などが選択される．シクロスポリン（CsA）は効果発現が早いため，迅速な判断が要求される重症度の高い症例に推奨される．血球成分除去療法は重症度がそれほど高くない中等症に推奨される．欧米では，急性期寛解導入治療には主としてCsAとIFXが用いられている．難治性UC活動期の救済治療としてCsA，タクロリムス，IFXの短期成績は良好で，改善率はそれぞれ約80％，約70％，約70％とする報告が多いが，今後さらなる検証が必要である．いずれの薬剤においても長期成績は良好とは言えず，半数に及ぶ症例が最終的に手術を余儀なくされている．難治性UCの寛解維持治療としてはアザチオプリンや6-MPが原則として使用されるが，IFXで寛解導入ができた例では寛解維持にIFXの8週ごとの維持投与が選択可能である．

参考文献

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