Randomised trial of mycophenolate mofetil versus azathioprine for treatment of chronic active Crohn's disease
Randomised trial of mycophenolate mofetil versus azathioprine for treatment of chronic active Crohn's disease
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DOI：
10.1136/gut.44.5.625
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发表时间：
1999-05-01
期刊：
影响因子：
24.5
通讯作者：
Schlaak, JF
中科院分区：
文献类型：
--
作者：
Neurath, MF;Wanitschke, R;Schlaak, JF
克罗恩病是一种消化道慢性炎症性疾病。硫唑嘌呤是治疗慢性活动性克罗恩病的有效药物，可长期缓解疾病活动。这种治疗导致有限的疗效或副作用，在一小部分patients. Aims的目的是比较疗效和副作用的治疗与硫唑嘌呤加皮质类固醇与霉酚酸酯（MMF）加皮质类固醇在慢性活动性克罗恩病患者。（克罗恩病活动指数（CDAI）大于150）随机接受硫唑嘌呤/可的松或MMF/可的松治疗。根据标准方案逐渐减少皮质类固醇剂量。疾病活动监测临床评分后，一，二，三，和六months. Results治疗中度活跃（CDAI 150-300）克罗恩病患者与MMF/可的松导致临床活动评分显着减少，与硫唑嘌呤/可的松治疗。与硫唑嘌呤/可的松治疗相比，使用MMF/可的松治疗高度活动性克罗恩病（CDAI大于300）患者可更早地显著抑制临床活动。与霉酚酸酯/可的松的治疗是与一些不良反应。结论-治疗慢性活动性克罗恩病与霉酚酸酯加可的松似乎是有效的，耐受性良好，应考虑在患者过敏的硫唑嘌呤或硫唑嘌呤失败。
Background-Crohn's disease is a chronic inflammatory disease of the alimentary tract. Azathioprine is an effective agent in the management of chronic active Crohn's disease leading to long term remission of disease activity. Such treatment leads to limited efficacy or side effects in a small subset of patients.Aims-To compare efficacy and side effects of treatment with azathioprine plus corticosteroids versus mycophenolate mofetil (MMF) plus corticosteroids in patients with chronic active Crohn's disease.Methods-Seventy patients with chronic active Crohn's disease (Crohn's disease activity index (CDAI) greater than 150) were randomised for treatment with azathioprine/cortisone or MMF/cortisone. Corticosteroid dosage was tapered according to a standard protocol. Disease activity was monitored by clinical scores after one, two, three, and six months.Results-Treatment of patients with moderately active (CDAI 150-300) Crohn's disease with MMF/cortisone led to a significant reduction in clinical activity scores comparable to treatment with azathioprine/cortisone. Treatment of patients with highly active Crohn's disease (CDAI greater than 300) with MMF/cortisone caused significant suppression of clinical activity earlier than azathioprine/cortisone treatment. Treatment with MMF/cortisone was associated with few adverse effects.Conclusion-Treatment of chronic active Crohn's disease with MMF plus cortisone appears to be effective and well tolerated and should be considered in patients allergic to azathioprine or in whom azathioprine has failed.