胃と腸47巻10号

2012年09月発行

今月の主題 難治性Crohn病の特徴と治療戦略

主題

IFX抵抗あるいは効果減弱例に対する対策

著者： 本谷聡¹ 山下真幸¹ 石井学¹ 田中浩紀¹ 今村哲理¹

所属機関： ¹札幌厚生病院IBDセンター

ページ範囲：P.1487 - P.1496

文献概要

要旨　インフリキシマブ（IFX）の臨床効果は，その有効血中濃度の維持によって決定される．したがって，IFX 5mg/kg 8週間隔投与での寛解維持が困難な場合には，投与間隔の短縮（IFX 5mg/kg 4週間隔投与：本邦未承認）や倍量投与（IFX 10mg/kg 8週間隔投与）により血中トラフ濃度を上昇させる必要がある．アダリムマブ（ADA）への変更や，血球成分吸着除去療法（GCAP/GMA）の併用も短期的には有用であるが，長期成績向上のためには治療の工夫を要する．効果減弱を回避するためには，チオプリン系免疫調節薬との併用も重要である．なお，効果減弱例での保存的治療の継続にあたっては，手術適応となる病態の合併にも十分留意し，手術時期をいたずらに遅らせることなく治療すべきである．

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