Treatment strategy for refractory inflammatory bowel disease to improve endoscopic lesions and long-term prognosis

Makoto Naganuma, Toshimutsu Fujii, Mamoru Watanabe

研究成果: Article

1 引用 (Scopus)

抄録

Ulcerative colitis (UC) and Crohn's disease (CD) is an inflammatory bowel disease of unknown aetiology characterized by periods of remission and acute episodes of relapse with severe inflammation in the colonic mucosa. Conventional treatments for UC and CD include 5-aminosalicylate, corticosteroid, elemental dietary treatment, corticosteroid, and thiopurine (azathioprine). Recently, new immunomodulators and anti-TNFa agents, such as tacrolimus, infliximab, and adalimumab have been developed and these treatments are available to be treated for patients with refractory UC and CD. Conventional step-up treatment has been replaced by top-down treatment using biologics. Infliximab and adalimumab induce not only clinical remission but also improve relapse rates and surgical rates. Endoscopic mucosal healing predicts short- and long-prognosis for both of these diseases, thus recent treatment strategy should be aimed for endoscopic remission. Although biologics is useful for patients with UC/CD, secondary loss of responses (LOR) for biologics has been partly observed in CD patients. Measuring antiinfliximab antibodies and concentration of infliximab trough level may help considering treatment strategy for patients with LOR.

元の言語English
ページ(範囲)99-106
ページ数8
ジャーナルJapanese Journal of Clinical Immunology
35
発行部数2
DOI
出版物ステータスPublished - 2012
外部発表Yes

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Inflammatory Bowel Diseases
Crohn Disease
Ulcerative Colitis
Biological Products
Therapeutics
Adrenal Cortex Hormones
Mesalamine
Recurrence
Azathioprine
Immunologic Factors
Tacrolimus
Mucous Membrane
Inflammation
Antibodies
Infliximab

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

これを引用

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AB - Ulcerative colitis (UC) and Crohn's disease (CD) is an inflammatory bowel disease of unknown aetiology characterized by periods of remission and acute episodes of relapse with severe inflammation in the colonic mucosa. Conventional treatments for UC and CD include 5-aminosalicylate, corticosteroid, elemental dietary treatment, corticosteroid, and thiopurine (azathioprine). Recently, new immunomodulators and anti-TNFa agents, such as tacrolimus, infliximab, and adalimumab have been developed and these treatments are available to be treated for patients with refractory UC and CD. Conventional step-up treatment has been replaced by top-down treatment using biologics. Infliximab and adalimumab induce not only clinical remission but also improve relapse rates and surgical rates. Endoscopic mucosal healing predicts short- and long-prognosis for both of these diseases, thus recent treatment strategy should be aimed for endoscopic remission. Although biologics is useful for patients with UC/CD, secondary loss of responses (LOR) for biologics has been partly observed in CD patients. Measuring antiinfliximab antibodies and concentration of infliximab trough level may help considering treatment strategy for patients with LOR.

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