Crohn病小腸病変に対する治療効果―インフリキシマブの粘膜治癒効果

Efficacy of Infliximab on Intestinal Lesions in Patients with Crohn's Disease

要旨　Crohn病に対する抗TNF-α抗体治療はインフリキシマブの開発により目覚ましい進歩を遂げた．単に炎症の改善のみにとどまらず，瘻孔の閉鎖や腸管の潰瘍治癒による腸管粘膜治癒という新しい概念を生み出し，患者QOLの向上をもたらした．しかし，維持投与中に効果が減弱あるいは消失するいわゆる効果減弱例や2次無効例が出現して，治療に難渋する症例がみられるようになった．インフリキシマブの効果減弱症例は，様々な投与法の工夫により臨床的寛解，またはそれに準じた状態に持ち込めるが，小腸に病変を有する症例の多くは臨床的に寛解状態であっても，内視鏡画像で小腸の粘膜治癒が得られていない．

　Infliximab is anti-TNF antibody therapy used for patients of Crohn's disease. QOL significantly improves with its use. It brings about not only improvement of lesion but also successful closure of inflammatory fistula. In addition, infliximab has ushered in the new concept of intestinal mucosal healing. However, while administrating this therapy, it sometimes becomes less effective or completely ineffective. There are many cases in which loss of effectiveness and secondary non-responsiveness makes them difficult to treat. The decrease in the effectiveness of this drug may be able to be solved by clinical ingenuity, taking the condition of the disease into account. But even in many cases of small intestine lesions in clinical remission, endoscopic mucosal healing is not attained.