Feasibility and response to budesonide as topical corticosteroid therapy for acute intestinal GVHD
Feasibility and response to budesonide as topical corticosteroid therapy for acute intestinal GVHD
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DOI：
10.1038/sj.bmt.1702055
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发表时间：
1999-12-01
影响因子：
4.8
通讯作者：
Finke, J
中科院分区：
文献类型：
--
作者：
Bertz, H;Afting, M;Finke, J
急性肠道GVHD的治疗仍然是异基因移植后的主要挑战之一。增加全身免疫抑制（IS）是首选，包括皮质类固醇和淋巴细胞抗体，通常与严重的副作用。在炎症性肠病如克罗恩病和溃疡性结肠炎中，局部类固醇治疗非常成功。由于这些与急性肠道GVHD之间的相似性，我们进行了一项口服布地奈德（布地诺福）的试验，一种新的局部活性糖皮质激素，治疗大于或等于II级的急性GVHD患者。在诊断为大于或等于II级的aGVHD后，22例患者接受了增加的IS，主要是全身性皮质类固醇，另外布地奈德9 mg/天，分为三个剂量。记录aGVHD改善、感染性副作用、全身IS减少和结局。结果与19例对照患者的结果进行了比较，这些患者仅通过增加IS剂量进行治疗。在17/22例患者（70%），用布地奈德治疗，急性肠道GVHD解决，并没有复发后，减少全身IS，而继续布地奈德。对照组中仅8/19例患者的急性肠道GVHD消退，2/8例患者在减少IS后肠道GVHD复发，总体缓解率为33%。未发生严重肠道感染。我们的结论是，布地奈德可能是有效的急性肠道移植物抗宿主病作为局部皮质类固醇和前瞻性，随机研究应证明其有效性，允许减少全身免疫抑制治疗，其副作用。
Therapy of acute intestinal GVHD is still one of the main challenges after allogeneic transplantation. Increasing systemic immunosuppression (IS) is the first choice and includes corticosteroids and lymphocyte antibodies, often associated with severe side-effects. In inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, topical steroid therapy is used very successfully. Because of the similarity between these and acute intestinal GVHD we conducted a trial with oral budesonide (Budenofalk), a new topically active glucocorticoid, to treat patients with acute GVHD greater than or equal to grade II. After a diagnosis of aGVHD greater than or equal to grade II, 22 patients received increased IS, mainly systemic corticosteroids, and additionally budesonide 9 mg/day divided into three doses. Improvement in aGVHD, infectious side-effects, reduction of systemic IS and outcome were documented. Results were compared with the results of 19 control patients, who were treated only by increasing IS dose. In 17/22 patients (70%), treated with budesonide, the acute intestinal GVHD resolved and no relapse occurred after decreasing the systemic IS, while continuing budesonide. In only 8/19 patients in the control group did the acute intestinal GVHD resolve and 2/8 patients had a relapse of intestinal GVHD after decreasing IS, with an overall response of 33%. No severe intestinal infections occurred. We conclude that budesonide may be effective in acute intestinal GVHD as a topical corticosteroid and prospective, randomized studies should demonstrate its efficacy in allowing reduction of systemic immunosuppressive therapy, and its side-effects.