Budesonide in the treatment of refractory celiac disease
Budesonide in the treatment of refractory celiac disease
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DOI：
10.1111/j.1572-0241.2007.01380.x
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发表时间：
2007-10-01
影响因子：
9.8
通讯作者：
Green, Peter H. R.
中科院分区：
文献类型：
--
作者：
Brar, Pardeep;Lee, Susie;Green, Peter H. R.
目的：皮质类固醇用于难治性乳糜泻患者。为了尽量减少其全身副作用，我们在一项开放标签非对照研究中评估了具有最小全身生物利用度的局部活性缓释皮质类固醇在难治性乳糜泻患者中的作用。方法：接受布地奈德治疗难治性乳糜泻的患者根据他们是否主要或次要对饮食无反应进行分类，以及它们是否具有上皮内淋巴细胞的多克隆（I型）或克隆（II型）扩增。布地奈德的反应进行了评估，全球和减少bowelmotions.RESULTS：患者（N = 29，72%的女性）接受布地奈德平均为6.7 +/- 8.5个月，5例（18%）有II型疾病（克隆T细胞群），76%的药物反应，55%完全。当布地奈德单独使用或与口服皮质类固醇和/或硫唑嘌呤联合使用时发生反应。在那些有反应的人中，排便次数客观上有所改善。无论是否存在显微镜下结肠炎，原发性或继发性难治性疾病患者和II型疾病患者均出现缓解（N = 7）。在研究期间，十二指肠活检没有改善，布地奈德也没有副作用。结论：布地奈德可能是在难治性乳糜泻的管理价值。
OBJECTIVE: Corticosteroids are used in patients with refractory celiac disease. In order to minimize their systemic side effects, we assessed the role of a locally active sustained release corticosteroid with minimal systemic bioavailability in patients with refractory celiac disease in an open labeled noncontrolled study.METHODS: Patients who received budesonide for refractory celiac disease were classified according to whether they were primarily or secondarily unresponsive to the diet, and whether they had a polyclonal (type I) or clonal (type II) expansion of intraepithelial lymphocytes. The response to budesonide was assessed globally and by reduction in bowel movements.RESULTS: Patients (N = 29, 72% female) received budesonide for a mean of 6.7 +/- 8.5 months, 5 patients (18%) had type II disease (clonal T-cell population); 76% responded to the medication, 55% completely. Response occurred when budesonide was used alone or with oral corticosteroids and/or azathioprine. There was an objective improvement in the number of bowel movements in those that responded. Response occurred in those with either primary or secondary refractory disease and in those with type II disease, irrespective of the presence of microscopic colitis (N = 7). There was no improvement in the duodenal biopsy over the study period and there were no side effects of budesonide.CONCLUSIONS: Budesonide may be of value in the management of refractory celiac disease.