JGH: 环孢素A与英夫利昔单抗治疗激素难治性急性重症溃疡性结肠炎疗效比较

2021-09-18 MedSci原创 MedSci原创

尽管生物制剂的使用显着改善了活动性溃疡性结肠炎 (UC),急性严重溃疡性结肠炎患者的预后,但是仍会有1-2%的死亡率。对于急性严重溃疡性结肠炎患者(ASUC)

      尽管生物制剂的使用显着改善了活动性溃疡性结肠炎 (UC),急性严重溃疡性结肠炎患者的预后,但是仍会有1-2%的死亡率。对于急性严重溃疡性结肠炎患者(ASUC),静脉注射 (IV) 类固醇的诱导治疗可用作为一线治疗方案。然而,30-40% 的 ASUC 患者表现出对类固醇诱导治疗无效。在此类患者中,推荐使用环孢菌素 A(一种钙调神经磷酸酶抑制剂)或与英夫利昔单抗(IFX,一种抗肿瘤坏死剂)治疗。本项研究旨在比较环孢素 A (CsA) 和英夫利昔单抗 (IFX) 作为亚洲人类固醇难治性急性严重溃疡性结肠炎 (SR-ASUC) 抢救疗法有效程度。

 

      在这项单中心研究中,研究人员对1995 年至 2015 年间接受 CsA 或 IFX 作为挽救治疗的 121 名 SR-ASUC 患者进行回顾性研究。比较了 3 个月时治疗失败和结肠切除术的累积率. 治疗失败被定义为结肠切除术、改用其他药物、需要类固醇治疗的急性发作事件或导致药物中断的不良事件。

 

 

      研究结果显示在 121 名 SR-ASUC 患者中,23 名接受 CsA 作为救援治疗。两组的基线特征(例如诊断时的年龄、性别、疾病持续时间、抢救治疗时的疾病程度和治疗开始时的 Mayo 评分)具有可比性。在随访期间,84 名患者(69.4%)经历了治疗失败,25 名患者(20.7%)接受了结肠切除术。CsA 组和 IFX 组在治疗失败(39.1% vs 34.7%,P= 0.714)和结肠切除术(26.1% vs 13.3%,P = 0.198) 没有明显差异 。既往使用硫唑嘌呤([OR]= 2.309,95%[CI] = 1.076–4.951,P= 0.032)与 3 个月的治疗失败相关。抢救治疗时 Mayo 评分>10与3个月内结肠切除术显着相关(OR = 8.444,95% CI = 2.592–27.506,P<0.001)。

 

      本项研究证实在SR-ASUC 患者中,CSA 和 IFX 治疗组在 3 个月时的治疗失败率和结肠切除术率没有显着差异。

 

 

原始出处:

Eun Mi Song. Et al. Comparison of outcomes of cyclosporine A and infliximab for steroid-refractory acute severe ulcerative colitis. Journal of Gastroenterology and Hepatology.2021.

 

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    2022-03-15 nymo
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    2021-09-20 freve

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