Mucosal healing with oral tacrolimus is associated with favorable medium- and long-term prognosis in steroid-refractory/dependent ulcerative colitis patients.
Mucosal healing with oral tacrolimus is associated with favorable medium- and long-term prognosis in steroid-refractory/dependent ulcerative colitis patients.
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DOI：
10.1016/j.crohns.2013.04.018
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发表时间：
2013-12-01
期刊：
影响因子：
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通讯作者：
Hibi, Toshifumi
中科院分区：
文献类型：
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作者：
Miyoshi, Jun;Matsuoka, Katsuyoshi;Hibi, Toshifumi
背景技术背景：口服他克莫司是激素难治性/依赖性溃疡性结肠炎（UC）的有效缓解诱导治疗方法，目的：评价他克莫司治疗UC的短期、中期和长期疗效。临床缓解和改善分别定义为Lichtiger评分≤ 4分和Lichtiger评分≤10分以及与基线评分相比评分降低≥3分。根据内镜活动指数和马约内镜评分对内镜检查结果进行评价。结果：62.7%的患者在3个月时观察到临床缓解和改善。36例患者在3个月时接受了结肠镜检查，12例（33.3%）和10例（27.8%）患者的马约内镜评分分别为0和1。在Kaplan-Meier分析中，不需要结肠切除术或转换为其他诱导治疗（如英夫利西单抗）的无事件生存者的总体百分比在6个月时为73.0%，1年时为49.9%，2年时为37.8%。3个月时马约内镜评分为0-1分的患者的中长期预后明显好于评分为2-3分的患者（p
BACKGROUND: Oral administration of tacrolimus is an effective remission induction therapy for steroid-refractory/dependent ulcerative colitis (UC).AIM: This study aimed to evaluate the short- as well as medium- and long-term effectiveness of tacrolimus therapy.METHODS: The medical records of 51 patients treated with tacrolimus for UC at our hospital between July 2009 and December 2011 were reviewed retrospectively. Clinical remission and improvement were defined as a Lichtiger score of 4 or less and as a Lichtiger score of ≤10 and a reduction in the score of ≥3 compared with the baseline score, respectively. Endoscopic findings were evaluated based on the endoscopic activity index and Mayo endoscopic score.RESULTS: The clinical effectiveness combining clinical remission and improvement was observed in 62.7% of the patients at 3 months. Thirty-six patients underwent colonoscopy at 3 months, and 12 (33.3%) and 10 patients (27.8%) showed Mayo endoscopic scores of 0 and 1, respectively. On Kaplan-Meier analysis, the overall percentage of event-free survivors, who did not require colectomy nor switching to other induction therapy such as infliximab, was 73.0% at 6 months, 49.9% at 1 year, and 37.8% at 2 years. Patients with a Mayo endoscopic score of 0-1 at 3 months showed significantly better medium- and long-term prognosis than those with a score of 2-3 (p