Anti-tumor necrosis factor monoclonal antibody therapy for gastrointestinal Behcet's disease: A case report
Anti-tumor necrosis factor monoclonal antibody therapy for gastrointestinal Behcet's disease: A case report
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DOI：
10.1053/gast.2001.22556
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发表时间：
2001-03-01
期刊：
影响因子：
29.4
通讯作者：
Vasiliauskas, EA
中科院分区：
文献类型：
--
作者：
Hassard, PV;Binder, SW;Vasiliauskas, EA
白塞病（BD）是一种多系统免疫介导的炎症性疾病，3%-26%的病例累及肠道。皮质类固醇、5-氨基水杨酸衍生物、免疫调节剂以及最近的沙利度胺和喷替福林已被用于治疗艾德，并取得了不同程度的成功。肿瘤坏死因子（TNF）-α被认为在这种T辅助细胞1型（Th 1）介导的疾病中起关键作用。英夫利昔单抗是一种抗肿瘤坏死因子-α的嵌合单克隆抗体，已被证明是克罗恩病和类风湿性关节炎的有效治疗方法，这两种疾病都是由Th 1介导的。我们描述了一个患者与慢性活动，激素依赖性艾德涉及胃肠道谁收到4剂英夫利昔单抗在6个月期间。因为她的大部分症状是胃肠道症状，克罗恩病活动指数（CDAI）被用来评估反应。观察到胃肠道和肠外症状的快速和显著改善。CDAI评分从270分（输注前）降至第2周的13分，尽管完全停用类固醇，但缓解仍持续。首次输注后10周进行的结肠镜检查显示内镜和组织学明显改善。本报告表明英夫利西单抗可能是治疗胃肠道艾德的有效新疗法，也可能是艾德的其他表现。
Behcet's disease (BD) is a multisystem immune-mediated inflammatory disorder that involves the intestine in 3%-26% of cases. Corticosteroids, 5-aminosalicylic acid derivatives, immunomodulators, and more recently thalidomide and pentoxifylline have been used to treat ED with varying degrees of success. Tumor necrosis factor (TNF)-alpha is believed to play a pivotal role in this T helper cell type 1 (Th1)-mediated disease. Infliximab, a chimeric monoclonal antibody to TNF-alpha, has been demonstrated to be an effective therapy for Crohn's disease and rheumatoid arthritis, 2 other Th1-mediated disorders. We describe a patient with chronically active, steroid-dependent ED involving the gastrointestinal tract who received 4 doses of infliximab during a 6-month period. Because most of her symptoms were gastrointestinal, the Crohn's Disease Activity Index (CDAI) was used to assess response. A rapid and dramatic improvement in both gastrointestinal and extraintestinal symptoms was observed. The CDAI score decreased from 270 points (preinfusion) to 13 points by week 2, and remission was sustained despite complete withdrawal of steroids. Colonoscopy performed 10 weeks after the first Infusion showed marked endoscopic and histologic improvement, This report suggests that infliximab may be an effective new therapy for gastrointestinal ED, and perhaps other manifestations of ED as well.