胃と腸48巻5号

2013年05月発行

特集 炎症性腸疾患 2013 主題 炎症性腸疾患の治療

免疫調節薬・抗TNF-α療法

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内科

ページ範囲：P.689 - P.694

炎症性腸疾患（IBD）における難治症例の寛解導入と長期寛解維持を目的に投与されてきた薬剤として免疫調節薬（IM）があり，主にアザチオプリン（AZA）/6-メルカプトプリン（6-MP）が用いられてきたが，その有効性は十分とは言えなかった．新規薬剤である抗TNF-α抗体インフリキシマブ（IFX）/アダリムマブ（ADA）はIM投与で改善を認めない症例に対しても有効性を発揮し，現在ではIBD治療の中心的薬剤として広く用いられている．しかし，抗TNF-α抗体療法においては投与中効果減弱を来す2次無効症例が出現するなど，今後解決しなければならない課題も明らかになってきた．それら課題の対処法として抗TNF-α抗体製剤にIMを併用する療法が有効とされているが，重篤な副作用発現の危険性もあり，併用療法の有効性と適切な実施法に関し，今後も慎重かつ詳細な検討が望まれる．

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