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中华消化病与影像杂志(电子版) ›› 2019, Vol. 09 ›› Issue (05) : 193 -195. doi: 10.3877/cma.j.issn.2095-2015.2019.05.001

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炎症性肠病药物联合治疗的获益与风险
李志1, 葛文松2,()   
  1. 1. 250012 济南,山东大学校医院趵突泉校区分院
    2. 200092 上海交通大学医学院附属新华医院消化内科
  • 收稿日期:2019-08-06 出版日期:2019-10-01
  • 通信作者: 葛文松

Benefits and risks of drug combination therapy for inflammatory bowel disease

Zhi Li1, Wensong Ge2,()   

  1. 1. School Infirmary, Baotu Spring Campus, Shandong University, Jinan 250012, China
    2. Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
  • Received:2019-08-06 Published:2019-10-01
  • Corresponding author: Wensong Ge
  • About author:
    Corresponding author: Ge Wensong, Eamil:
引用本文:

李志, 葛文松. 炎症性肠病药物联合治疗的获益与风险[J]. 中华消化病与影像杂志(电子版), 2019, 09(05): 193-195.

Zhi Li, Wensong Ge. Benefits and risks of drug combination therapy for inflammatory bowel disease[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2019, 09(05): 193-195.

目前炎症性肠病(IBD)的发病机制未完全明确,虽有越来越多的生物制剂问世,但其治疗仍存在难点,有时无法得到令人满意的疗效。在临床实践中,当常规治疗收效不佳时,将几种药物联合应用治疗IBD不失为一种重要的治疗策略,但药物联合治疗提高疗效的同时可能会增加感染及肿瘤等风险。因此应用联合治疗时需结合患者的疾病类型、病情程度、病变范围、高危因素、既往用药情况,对治疗方案进行技巧性地选择和甄别必不可少。

At present, the pathogenesis of inflammatory bowel disease (IBD) is not completely clear. Although more and more biological agents are available, there are still difficulties in the treatment of IBD. In clinical practice, when conventional treatment is not effective, combining several drugs to treat IBD may be an important treatment strategy.But the combination of drugs may increase the risk of infection and tumor while improving the efficacy. Therefore, the application of combined therapy should be selected skillfully combined with the patient′s disease type, disease degree, lesion range, high risk factors and previous medication.

1
Marteau P, Probert CS, Lindgren S, et al.Combined oral and enema treatment with Pentasa(mesalazine)is superior to oral therapy alone in patients with extensive mild/moderate activeulcerative colitis: a randomised, double blind, placebo controlled study[J]. Gut, 2005, 54(7): 960-965.
2
D′Albasio G, Pacini F, Camarri E, et al.Combined therapy with 5-aminosalicylic acid tablets and enemas for maintaining remission in ulcerative colitis: a randomized double-blind study[J]. Am J Gastroenterol, 1997, 92(7): 1143-1147.
3
Malchow H, Ewe K, Brandes JW, et al.European Cooperative Crohn′s Disease Study(ECCDS): results of drug treatment[J]. Gastroenterology, 1984, 86(2): 249-266.
4
Blaker PA, Arenas-Hernandez M, Smith MA, et al.Mechanism of allopurinol induced TPMT inhibition[J]. Biochem Pharmacol, 2013, 86(4): 539-547.
5
Smith MA, Blaker P, Marinaki AM, et al.Optimising outcome on thiopurines in inflammatory bowel disease by co-prescription of allopurinol[J]. J Crohns Colitis, 2012, 6(9): 905-912.
6
Campbell S, Ghosh S. Effective maintenance of inflammatory bowel disease remission by azathioprine does not require concurrent 5-aminosalicylate therapy[J]. Eur J Gastroenterol Hepatol, 2001, 13(11): 1297-1301.
7
Mantzaris GJ, Sfakianakis M, Archavlis E, et al.A prospective randomized observer-blind 2-year trial of azathioprine monotherapy versus azathioprine and olsalazine for the maintenance of remission of steroid-dependent ulcerative colitis[J]. Am J Gastroenterol, 2004, 99(6): 1122-1128.
8
Mate-Jimenez J, Hermida C, Cantero-Perona J, et al.6-Mercaptopurine or methotrexate added to prednisone induces and maintains remission in steroid-dependent inflammatory bowel disease[J]. Eur J Gastroenterol Hepatol, 2000, 12(11): 1227-1233.
9
Ewe K, Press AG, Singe CC, Stufler M, et al.Azathioprine combined with prednisolone or monotherapy with prednisolone in active Crohn′s disease[J]. Gastroenterology, 1993, 105(2): 367-372.
10
Vasudevan A, Raghunath A, Anthony S, et al.Higher Mucosal Healing with Tumor Necrosis Factor Inhibitors in Combination with Thiopurines Compared to Methotrexate in Crohn′s Disease[J]. Dig Dis Sci, 2019, 64(6): 1622-1631.
11
Panaccione R, Ghosh S, Middleton S, et al.Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis[J]. Gastroenterology, 2014, 146(2): 392-400.e3.
12
Kopylov U, Al-Taweel T, Yaghoobi M, et al.Adalimumab monotherapy versus combination therapy with immunomodulators in patients with Crohn′s disease: a systematic review and meta-analysis[J]. J Crohns Colitis, 2014, 8(12): 1632-1641.
13
Feagan BG, McDonald JW, Panaccione R, et al.Methotrexate in combination with infliximab is no more effective than infliximab alone in patients with Crohn′s disease[J]. Gastroenterology, 2014, 146(3): 681-688.e1.
14
Colman RJ, Rubin DT.Optimal doses of methotrexate combined with anti-TNF therapy to maintain clinical remission in inflammatory bowel disease[J]. J Crohns Colitis, 2015, 9(2): 312-317.
15
Cortes X, Borras-Blasco J, Fernendez S, et al.Successful use of infliximab and tacrolimus combination therapy in a patient with ulcerative colitis refractory to infliximab dose intensification plus azathioprine[J]. Int J Clin Pharmacol Ther, 2016, 54(2): 125-128.
16
Bots S, Gecse K, Barclay M, et al.Combination Immunosuppression in IBD[J]. Inflamm Bowel Dis, 2018, 24(3): 539-545.
17
Lowry PW, Weaver AL, Tremaine WJ, et al.Combination therapy with oral ta-crolimus(FK506)and azathioprine or 6-mer-captopurine for treatment-refractory Crohn′s disease perianal fistulae[J]. Inflamm Bowel Dis, 1999, 5(2): 239-245.
18
Tanida S, Mizoshita T, Nishie H, et al.Combination therapy with adalimumab plus intensive granulocyte and monocyte adsorptive apheresis in patients with refractory ulcerative colitis[J]. J Clin Med Res, 2015, 7(11): 884-889.
19
Chi LY, Zitomersky NL, Liu E, et al.The Impact of Combination Therapy on Infliximab Levels and Antibodies in Children and Young Adults With Inflammatory Bowel Disease[J]. Inflamm Bowel Dis, 2018, 24(6): 1344-1351.
20
Colombel JF, Sandborn WJ, Panaccione R, et al.Adalimumab safety in global clinical trials of patients with Crohn′s disease[J]. Inflamm Bowel Dis, 2009, 15(9): 1308-1319.
21
Singh S, Facciorusso A, Dulai PS, et al.Comparative Risk of Serious Infections With Biologic and/or Immunosuppressive Therapy in Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis[J]. Clin Gastroenterol Hepatol, 2019, S1542-3565(19)30255-1.
22
Deepak P, Sifuentes H, Sherid M, et al.T-cell non-Hodg-kin′s lymphomas reported to the FDA AERS with tumor necrosis factor-alpha(TNF-α)in-hibitors: results of the REFURBISH study[J]. Am J Gastroenterol, 2013, 108(1): 99-105.
23
Papamichael K, Mantzaris GJ, Peyrin-Biroulet L. A safety assessment of anti-tumor ne-crosis factor alpha therapy for treatment of Crohn′s disease[J]. Expert Opin Drug Saf, 2016, 15(4): 493-501.
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