Tacrolimus for the Treatment of Ulcerative Colitis.
Tacrolimus for the Treatment of Ulcerative Colitis.
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他克莫司用于治疗溃疡性结肠炎。
DOI：
10.5217/ir.2015.13.3.219
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发表时间：
2015-07
影响因子：
4.9
通讯作者：
Watanabe M
中科院分区：
文献类型：
--
作者：
Matsuoka K;Saito E;Fujii T;Takenaka K;Kimura M;Nagahori M;Ohtsuka K;Watanabe M
他克莫司是一种钙调磷酸酶抑制剂，用于治疗皮质类固醇难治性溃疡性结肠炎 (UC)。两项随机对照试验和多项回顾性研究评估了他克莫司对 UC 患者的治疗效果。这些研究表明，他克莫司对皮质类固醇难治性患者具有优异的短期疗效，临床缓解率为 61% 至 96%。然而，接受他克莫司治疗的患者的长期预后令人失望，在长期随访中几乎50%的患者最终接受了结肠切除术。他克莫司可以使 40-50% 的患者实现粘膜愈合，这与良好的长期预后相关。抗肿瘤坏死因子 (TNF)-α 抗体是皮质类固醇难治性患者的另一种治疗选择。目前正在进行一项他克莫司和英夫利昔单抗的前瞻性头对头比较研究，以确定哪种治疗对皮质类固醇难治性患者更有效。几项回顾性研究表明，他克莫司和抗 TNF-α 抗体疗法之间的转换对于其中一种疗法难治的患者是有效的。他克莫司的大多数不良事件都是轻微的；然而，机会性感染，尤其是肺孢子虫肺炎，是最重要的不良事件，在治疗过程中应仔细考虑。 UC 患者他克莫司治疗的几个问题仍未解决（例如，使用他克莫司作为缓解维持治疗）。需要进一步的对照研究来优化他克莫司治疗 UC 的用途。
Tacrolimus is a calcineurin inhibitor used for the treatment of corticosteroid-refractory ulcerative colitis (UC). Two randomized controlled trials and a number of retrospective studies have assessed the therapeutic effect of tacrolimus in UC patients. These studies showed that tacrolimus has excellent short-term efficacy in corticosteroid-refractory patients, with the rates of clinical response ranging from 61% to 96%. However, the long-term prognosis of patients treated with tacrolimus is disappointing, and almost 50% of patients eventually underwent colectomy in long-term follow-up. Tacrolimus can achieve mucosal healing in 40-50% of patients, and this is associated with a favorable long-term prognosis. Anti-tumor necrosis factor (TNF)-α antibodies are another therapeutic option in corticosteroid-refractory patients. A prospective head-to-head comparative study of tacrolimus and infliximab is currently being performed to determine which treatment is more effective in corticosteroid-refractory patients. Several retrospective studies have demonstrated that switching between tacrolimus and anti-TNF-α antibody therapy was effective in patients who were refractory to one of the treatments. Most adverse events of tacrolimus are mild; however, opportunistic infections, especially pneumocystis pneumonia, are the most important adverse events, and these should be carefully considered during treatment. Several issues on tacrolimus treatment in UC patients remain unsolved (e.g., use of tacrolimus as remission maintenance therapy). Further controlled studies are needed to optimize the use of tacrolimus for the treatment of UC.