英夫利昔单抗治疗炎症性肠病失应答的研究进展

英夫利昔单抗(IFX)是首个用于治疗炎症性肠病(IBD)的生物制剂,对传统治疗效果不佳的中重度活动性克罗恩病和溃疡性结肠炎疗效显著.然而,部分患者疗效欠佳甚至是无疗效,称为药物的失应答(LOR).研究显示,10％ ～30％患者对IFX起始治疗无应答,但起始应答较好而随着时间推移又失去疗效的患者比例高达50％.目前LOR...     

英夫利昔单抗治疗炎症性肠病后诱发银屑病的研究进展

英夫利昔单抗(IFX)是针对肿瘤坏死因子-α的嵌合人鼠单克隆免疫球蛋G1抗体,在我国已被广泛应用于炎症性肠病(IBD)及银屑病的治疗,且疗效显著.然而,有意思的是,近年来IFX治疗IBD后诱发、加重银屑病的报道逐渐增多,在IBD的基础上并发银屑病,进一步加重患者病情,IFX相关性银屑病的发病特点、发病机制、临床诊疗等问...     

英夫利昔单抗治疗炎症性肠病的潜在风险

抗肿瘤坏死因子-α(anti-TNF-α)是新型的能够有效治疗难治性炎症性肠病(IBD)的药物,但也有许多不良反应,需要小心监控治疗。其中英夫利昔单抗的应用最为广泛,本文对其治疗IBD的潜在风险进行综述,包括输液反应、恶性肿瘤、结核、感染、红斑狼疮等。     

溃疡性结肠炎应用英夫利昔单抗后出现掌跖脓疱病一例

英夫利昔单抗(Infliximab,IFX),作为一种肿瘤坏死因子-α拮抗剂(Tumor necrosis factor-αantagonist,TNF-αAntagonist),是中-重度溃疡性结肠炎(Ulcerative colitis,UC)的一线用药。目前,英夫利昔单抗(Infliximab,IFX)为国内外应用最广的生物制剂。溃疡性结肠炎是一种可全结肠受累的自身免疫性肠道炎性疾病,是炎症性肠病(Inflammatory bowel disease,IBD)的一种亚型;英夫利昔单抗的疗效在溃疡性结肠炎中得到广泛认可,但用药期间的不良反应发生率正大幅提高,尤其是皮肤系统的不良反应事件,本文报道了1例在应用英夫利昔单抗后出现掌跖脓疱病的病例,经专科干预后病情有所好转,病变持续了半年之久,在整个病程中未停止英夫利昔单抗的治疗,分析其中原因,可能与应用类克的累积剂量相关。提示我们在使用英夫利昔单抗的同时注意药物安全性,及时采取必要的措施,尽量避免不良反应,以免导致病情加重。     

英夫利昔单抗联合挂线治疗克罗恩病肛瘘近远期疗效观察

目的 研究英夫利昔单抗和挂线联合疗法用于克罗恩病肛瘘中的价值.方法 2015年3月至2018年2月本院接诊的克罗恩病肛瘘病患70例,按照数字抽签原理均分两组.研究组联用英夫利昔单抗和挂线疗法,对照组联用硫唑嘌呤和挂线疗法.对比CD4+ CD25+Treg等指标.结果 研究组治疗后PCDAI评分(3.21±1.07)分、...     

英夫利昔单抗治疗强直性脊柱炎临床观察

目的探讨英夫利昔单抗治疗治疗强直性脊柱炎的疗效。方法回顾性分析2010年1月至2011年1月惠州市第三人民医院采用英夫利昔单抗治疗53例强直性脊柱炎患者的临床资料。结果所有患者经过治疗后,临床治愈13例(24.53%),显效15例(28.30%),有效19例(35.85%),无效6例(11.32%),总有效率达88.68%(47/53);所有患者在感染,充血性心力衰竭以及肝、肾功能及血液系统等方面的受损情况均未出现。结论英夫利昔单抗治疗强直性脊柱炎疗效明显,副作用底,值得临床推广运用。     

英夫利昔单抗治疗类风湿关节炎的临床研究

目的探讨英夫利昔单抗治疗类风湿关节炎的临床疗效,为临床合理用药提供参考。方法回顾性分析我院风湿免疫科2013年10月至2015年6月收治的30例患者应用英夫利昔单抗治疗类风湿关节炎的情况,观察患者治疗前后症状、体征及实验室检查等情况。结果治疗后患者的血沉和CRP明显降低,病情活动情况明显减轻。30例患者中,1例出现局部注射反应,2 d内可自动消失。其余患者未发现明显不良反应。结论英夫利昔单抗能明显改善RA等风湿免疫疾病的炎症反应,抑制关节破坏进展,改善患者的临床表现及预后。     

英夫利昔单抗治疗强直性脊柱炎的疗效观察

目的：探讨英夫利昔单抗治疗强直性脊柱炎（AS）的效果及安全性。方法：将60例确诊为AS并符合应用生物制剂的患者以随机抽样法分为对照组和观察组各30例,对照组患者在口服甲氨蝶呤的基础上应用柳氮磺胺吡啶等改善病情的药物;观察组患者在口服甲氨蝶呤的基础上联合应用英夫利昔单抗。观察2组患者治疗12周后的效果及治疗6、12周时的临床和实验室指标及不良反应发生情况。结果：治疗12周后,观察组患者疗效明显优于对照组（P〈0．05）。治疗6、12周后,观察组患者的Bath强直性脊柱炎病情活动指数评分（BASDAI）、Bath强直性脊柱炎功能指数（BASFI）、脊柱痛、晨僵、胸廓扩张度、C反应蛋白（CRP）、细胞沉降率（ESR）、腰椎活动度试验（Schober）等指标均明显优于治疗前,且与对照组比较,差异具有统计学意义（P〈O．05）;治疗6周后,对照组患者晨僵、ESR、BASFI较治疗前有显著改善（P〈0．05）,治疗12周后,对照组患者除血小板计数（PLT）、白细胞计数（WBC）、心率（HR）等指标外,其他指标较治疗前有明显改善（P〈0．05）。治疗6、12周后,2组患者的PLT、WBC下降,较治疗前均有显著差异（P〈0．05）,但2组间比较差异无统计学意义（P〉0．05）;2组患者治疗前后HR无明显变化（P〉0．05）;2组均未见明显不良反应。结论：英夫利昔单抗治疗AS,可以更早期地达到诱导、缓解病情的目的,较为安全、有效。     

英夫利昔治疗炎症性肠病安全有效

本研究评价了英夫利昔（IFX）治疗炎症性肠病的安全性和有效性。     

英夫利昔单抗联合硫唑嘌呤治疗儿童克罗恩病的药学监护

目的:探讨临床药师在儿童克罗恩病个体化治疗中的药学监护作用。方法:1例克罗恩病患儿拟应用英夫利昔单抗联合硫唑嘌呤治疗;临床药师以免疫调节治疗方案的选择、给药剂量的调整及药品不良反应监测等为切入点,结合基因检测,根据患儿实际情况,配合临床制定个体化给药方案及监护计划。结果:临床药师协助临床医师制定了合理的治疗方案,使患儿症状得到控制,降低了药物发生不良反应的风险。结论:在临床治疗过程中,临床药师发挥药学专业优势,优化给药方案,可减少药物不良反应,促进临床合理用药。     

英夫力西治疗炎症性肠病与肠道菌群改变的相关性研究

目的探讨使用英夫力西(IFX)治疗炎症性肠病与肠道菌群改变的关系。方法收集104例炎症性肠病患者,其中溃疡性结肠炎(UC)52例,克罗恩病(CD)52例,使用英夫力西治疗前后测定肠道菌群数量。另取30例健康志愿者新鲜粪便,定量培养进行菌群分析,同时测定三组C反应蛋白、血沉两项数据结果,分析其与肠道细菌组成变化的相关性。结果治疗后,UC组酵母菌(1.09±0.17)、肠球菌(5.01±0.36)和消化球菌(3.99±0.23)的数量显著下降,乳酸杆菌(7.95±0.69)的数量显著上升(P<0.01);CD组酵母菌(1.06±0.19)、肠球菌(4.91±0.37)和消化球菌(3.90±0.19)的数量显著下降,乳酸杆菌(8.07±0.76)的数量显著上升(P<0.01)。治疗后,UC组CRP(10.33±4.64)、ESR(9.10±4.11)水平降低(P<0.01);CD组CRP(7.31±4.68)、ESR(9.27±3.13)水平降低(P<0.01)。结论使用英夫力西治疗炎症性肠病患者后,酵母菌、肠球菌和消化球菌数量显著降低,乳酸杆菌数量显著增加,恢复到正常水平,炎症指标CRP和ESR下降,临床症状得到有效缓解。     

益生菌对炎症性肠病的治疗作用分析

目的：观察益生菌治疗炎症性肠病的临床效果。方法：选取本院160例炎症性肠病患者,将患者随机分为治疗组和对照组。对对照组患者进行单纯柳氮磺胺吡啶片治疗,对治疗组患者使用柳氮磺胺吡啶片联合益生菌治疗,对比治疗效果。结果：治疗组有效率达到92．5％,出现并发症1例;对照组有效率仅为75．0％,出现并发症4例。治疗组治疗效果明显好于对照组（P〈0．05）,两组差异具有统计学意义。结论：益生菌可以明显提升炎症性肠病治疗效果,改善临床控制有效率,值得临床推广。     

New developments in the pharmacotherapy of inflammatory bowel disease

In this article the clinical features and aetiology of inflammatory bowel diseases are described and current pharmacotherapeutic possibilities are explored. Also reviewed are recent developments and future prospects for the pharmacotherapy of inflammatory bowel diseases, including aminosalicylates, corticosteroids, immunosuppressants, lipoxygenase inhibitors, fish oil, sucralfate, bismuth compounds, free radical scavengers, (hydroxy)chloroquine, sodium cromoglycate and methotrexate.     

A new target for the treatment of inflammatory bowel disease: Interleukin-37

Interleukin (IL)-37 belongs to the IL-1 cytokine family. It has anti-inflammatory effects on numerous autoimmune diseases such as asthma, psoriasis, inflammatory bowel disease (IBD), systemic lupus erythematosus (SLE), multiple sclerosis (MS) and rheumatoid arthritis (RA). Mechanistically, IL-37 plays an anti-inflammatory role by regulating the expression of inflammatory factors in two ways: binding extracellular receptors IL-18R or transferring into the nucleus with Smad3. IBD is a kind of idiopathic intestinal inflammatory disease with unknown etiology and pathogenesis. Recent researches had proved that IL-37 is negatively involved in the pathogenesis and development of IBD. Among various inflammatory diseases, IL-37 has been shown to regulate inflammatory development by acting on various immune cells such as neutrophils, macrophages (Mϕ), dendritic cells (DCs), T cells and intestinal epithelial cells. This review summarizes the biological role of IL-37, and its immunoregulatory effects on the immune cells, especially anti-inflammatory function in both human and experimental models of IBD.     

Alicaforsen for the treatment of inflammatory bowel disease

Introduction: Intracellular adhesion molecule-1 (ICAM-1), is a transmembrane glycoprotein of the immunoglobulin family, constitutively expressed on vascular endothelial cells and upregulated in inflamed colonic tissue. Alicaforsen, a 20 base ICAM-1 anti-sense oligonucleotide and highly selective ICAM-1 inhibitor, down-regulates ICAM-1 mRNA.

Areas covered: We review mechanism of action, pharmacokinetics, pre-clinical, clinical and safety data of alicaforsen for the treatment of ulcerative colitis (UC), pouchitis and Crohn’s disease (CD).

Expert opinion: After 6 weeks of treatment, topical alicaforsen was significantly more effective than placebo in inducing remission in patients with moderate-severe distal UC, with treatment effects lasting up to 30 weeks. No difference was observed in head-head comparison with mesalamine topical enema, although alicaforsen appeared to have more durable treatment effect. Clinical trials of an intravenous formulation in Crohn’s disease showed no significant treatment effect compared to placebo. An open-label trial in alicaforsen for pouchitis demonstrated encouraging results, now being assessed in a multi-national phase 3 trial. No major safety signals have been observed in UC patients treated with alicaforsen enemas. The potential as a novel therapy for pouchitis has led to orphan designation for this indication by the FDA and European Medicines Agency.     

间充质干细胞在炎症性肠病治疗中的研究进展

现代医学研究表明炎症性肠病的发病机制与患者免疫失调具有密切关系。目前临床对于炎症性肠病治疗主要原则为消除活动性炎症以及改善免疫功能紊乱,比如氨基水杨酸制剂、免疫抑制剂以及糖皮质激素等均是临床治疗常用药物。间充质干细胞为具有自我复制以及多方向分化潜能的成体干细胞,对于组织修复以及免疫调节等均具有良好的治疗效果,目前在心肌梗死以及系统性红斑狼疮等疾病治疗中应用较为广泛。近些年很多专家将间充质干细胞应用于炎症性肠病的治疗中,取得了良好的效果。本文将这些新研究进展进行综述,以期为炎症性肠病的临床治疗提供借鉴。     

消化内镜在炎症性肠病诊治中的临床应用

目的探讨消化内镜在炎症性肠病诊治中的临床价值,为今后炎症性肠病的诊治提供临床依据。方法回顾性分析我院2008年7月至2010年8月收治的45例炎症性肠病(IBD)患者的临床资料,总结镜下所见并评价内镜诊断价值。结果镜下可见IBD患者黏膜充血、糜烂、溃疡、水肿、黏膜脆性增加及容易出血等变化,与手术后病检或上级医院诊断相比,内镜诊断准确性为84.44%,其中溃疡性结肠炎(UC)和克罗恩病(CD)的诊断准确性分别为92.43%和60%。结论内镜在IBD的诊断中有相对特异性,具有重要的临床价值。     

Long-term treatment with infliximab in inflammatory bowel disease: safety and tolerability issues

Crohn's disease and ulcerative colitis represent the most common forms of inflammatory bowel disease (IBD), clinical conditions affecting the small and/or large bowel. It is well known that IBD is an immune-mediated condition and that TNF-α plays a pivotal role in the pathogenesis of the disease. TNF-α has been scrupulously studied as a target for therapeutic intervention in this setting. A number of biologic compounds have been developed, including the European Medicine Agency (EMEA)-approved agents, infliximab and adalimumab. Although their efficacy in induction and maintenance of remission has been established by several clinical trials, many issues regarding safety remain to be elucidated. In fact, anti-TNF treatment may be associated with a number of rare, but serious, adverse events, including infusion reactions, infections, lymphomas and other malignancies. A black-box warning has to be taken into consideration when looking at potential serious infections such as tuberculosis. Active infections, demyelinating disorders and severe heart failure are contraindications for anti-TNF treatment. This review focuses on drug toxicity and adverse events related to infliximab treatment in IBD.     

5-aminosalicylic acid preparations in the treatment of inflammatory bowel disease

Multiple new 5-aminosalicylic acid preparations have joined sulphasalazine in our armamentarium of agents for the treatment of inflammatory bowel disease. Rowasa enemas are clearly an advance in our ability to treat distal ulcerative colitis. Oral 5-ASA analogues are equivalent to sulphasalazine in maintaining ulcerative colitis in remission but may have some increased efficacy in high doses for treating mild to moderate active ulcerative colitis. These agents are particularly useful in the sulphasalazine-intolerant individual. Some of the new 5-ASA preparations have been found to be helpful in the treatment of active Crohn’s disease. There is hope that the newer agents having distal small bowel drug release may be beneficial in maintaining Crohn’s disease in remission.