Impact of Infliximab Therapy After Early Endoscopic Recurrence Following Ileocolonic Resection of Crohn's Disease: A Prospective Pilot Study
Impact of Infliximab Therapy After Early Endoscopic Recurrence Following Ileocolonic Resection of Crohn's Disease: A Prospective Pilot Study
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DOI：
10.1002/ibd.20915
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发表时间：
2009-10-01
影响因子：
4.9
通讯作者：
Matsumoto, Koichi
中科院分区：
文献类型：
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作者：
Yamamoto, Takayuki;Umegae, Satoru;Matsumoto, Koichi
背景：英夫利西单抗治疗克罗恩病（CD）切除术后内镜下复发的疗效尚未报道。本前瞻性研究的目的是探讨英夫利西单抗对CD切除术后早期内镜病变的影响。方法：26例切除术后用美沙拉嗪（3 g/天）维持临床缓解（CD活动指数[CDAI]评分< 150）的患者在术后6个月（=基线）显示新末端回肠内镜复发。在接下来的6个月内，10例患者接受连续美沙拉嗪治疗（3 g/天），8例患者接受硫唑嘌呤治疗（50 mg/天），其他8例患者接受英夫利西单抗治疗（5 mg/kg，每8周一次）。结果：在6个月的观察中，英夫利昔单抗组无患者发生临床复发（CDAI ≥ 150），硫唑嘌呤组3例（38%），美沙拉嗪组7例（70%），差异有统计学意义（P = 0.01）。在6个月时，英夫利西单抗组75%的患者、硫唑嘌呤组38%的患者和美沙拉嗪组0%的患者的内镜炎症得到改善（P = 0.006）。粘膜白细胞介素（IL）-1 β，IL-6，和肿瘤坏死因子-α水平显着降低英夫利昔单抗组，而他们显着增加美沙拉嗪组，他们没有显着改变azathioprine group.Conclusions：英夫利昔单抗治疗显示出明确的抑制作用油临床和内镜下疾病的活动，和粘膜细胞因子的产生与早期内镜下病变切除术后的患者。为了证实我们的结论，需要大量患者的随机对照试验。
Background: The efficacy of infliximab for endoscopic recurrence after resection of Crohn's disease (CD) has not yet been reported. The aim of this prospective Study was to investigate the impact of infliximab on early endoscopic lesions after resection for CD.Methods: Twenty-six patients maintaining clinical remission (CD activity index [CDAI] score < 150) with mesalamine (3 g/day) after resection showed endoscopic recurrence in the neoterminal ileum at 6 months postoperatively (=baseline). Over the following 6 months, 10 patients were treated with continuous mesalamine (3 g/day), 8 patients were treated with azathioprine therapy (50 mg/day) and the other 8 patients were treated with infliximab therapy (5 mg/kg, every 8 weeks). During ileocolonoscopy at baseline and 6 months later, mucosal biopsies were taken for cytokine assays.Results: During 6-month observation, no patients in the infliximab group, 3 (38%) in the azathioprine group, and 7 (70%) in the mesalamine group developed clinical recurrence (CDAI >= 150) (P = 0.01). At 6 months, endoscopic inflammation was improved in 75% of patients in the infliximab group, 38% in the azathioprine group, and 0% in the mesalamine group (P = 0.006). The mucosal interleukin (IL)-1 beta, IL-6, and tumor necrosis factor-alpha levels significantly decreased in the infliximab group, while they significantly increased in the mesalamine group, and they did not change significantly in the azathioprine group.Conclusions: Infliximab therapy showed clear Suppressive effects oil clinical and endoscopic disease activity, and mucosal cytokine production in patients with early endoscopic lesions after resection. To confirm our conclusions, randomized controlled trials with a larger number of patients are necessary.