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二次無効の病態

著者： 鈴木康夫¹

所属機関： ¹東邦大学医療センター佐倉病院消化器内科

ページ範囲：P.1497 - P.1502

要旨　インフリキシマブ（IFX）は，難治性Crohn病に対しても高率に寛解導入とその後の長期寛解維持を実現する有効な治療薬であることが実証されてきた．しかし，IFX投与に際していくつかの課題が明らかにされ，それらの中でIFX二次無効の出現は臨床上早急に解決が求められる大きな課題となっている．二次無効症例発現に至る詳細な機序はいまだ明確ではないが，IFXに反応する抗体が産生され有効IFX血中濃度の低下を招くなど，個々の症例における適正血中IFX濃度が維持されず，病勢を抑制できなくなることが大きな要因と考えられる．Crohn病においては寛解導入とその後の長期寛解維持を実現することが治療目標であり，長期寛解維持を阻害する二次無効出現の病態を明らかにし，適切に対処することが重要である．

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