Crohn病におけるinfliximab治療―粘膜治癒の維持と腸病変の推移

Optimizing and Successful Treatment of Infliximab for Patients with Crohn's Disease―in Terms of Maintenance of Mucosal Healing

要旨　内視鏡による大腸病変の改善率は，0，2，6週投与後71.4％に達したが，瘢痕治癒率は21.4％に過ぎなかった．計画的維持投与の継続により，瘢痕治癒率は，1年後43.5％，2年後64.7％，3年後で70.0％に向上し，infliximab計画的維持投与による継続したTNF-αの制御がCrohn病病変の治癒に繋がる可能性をも示すものと思われた．さらに，計画的維持投与による非再入院率は，1年で86.7％，2年で69.3％，3年でも57.5％であり，既存の維持治療に比べ有意に優れていた．よって，0，2，6週投与と8週間ごとに再投与を繰り返す計画的維持投与は，長期的な緩解維持と病変の瘢痕治癒をも視野に含めた，Crohn病に対するより良いinfliximab治療であると考えられた．

　We investigated mucosal healing rate and rehospitalization rate for patients with Crohn's disease (CD) who underwent scheduled maintenance infusion of infliximab. Scheduled maintenance infusion improved healing rate to 43.5％ after 1 year, 64.7％ after 2 years, 70.0％ after 3 years respectively, in spite of there being initially only a 21.4％ healing rate without this scheduled infusion of infliximab. It seemed that continuous regulation of TNF-αled to mucosal healing of active longitudinal ulcers caused by CD. Also, it significantly improved rehospitalization rate compared with that of conventional therapy such as elemental nutrition and immuno-modulators including episodic infusion of infliximab. These results shows scheduled maintenance infusion every 8 weeks following triple initial infusion of infliximab has been an optimizing and successful procedure enabling the maintenance of long-term remission of CD.