治療面からみた腸管Behçet病・単純性潰瘍の経過―抗TNF-α抗体（インフリキシマブ）投与例の検討

The Effect of Anti-TNF-αAntibody in Refractoy Intestinal Behçet's Disease and Simple Ulcer

要旨　当院でインフリキシマブ投与を行ったステロイドなど既存の治療に抵抗性の腸管Behçet病，単純性潰瘍9例の初期治療効果および維持療法の成績，安全性を検討した．インフリキシマブ投与は0，2，6週の3回投与後，8週ごとの維持投与を基本とした．寛解導入目的に投与した8例中7例に有効で臨床症状の改善・消失をみた．無効例の1例は既手術例の吻合部の再発で狭窄・瘻孔を合併していた症例で，症状に改善がなく手術を施行した．術後再発予防目的に投与を行った1例は現在も寛解を維持している．維持投与は8例に継続中であり，全例で明らかな腸病変再発の徴候は認めず寛解を維持しており，現時点まで副作用を認めた症例はない．以上の結果から，インフリキシマブは腸管Behçet病および単純性潰瘍の難治例の治療として，初期治療効果および維持効果ともに有用な薬剤であることが示された．

　To assess the effectiveness of anti-TNF（tumor necrosis factor）-αantibody（infliximab）in the short-and long-term and its safety in intestinal Behçet's disease and simple ulcer, we analyzed 9 patients who were treated with infliximab at Keio University Hospital. All patients had deep, undermining, oval ulcers in the ileocecal lesion and the anastomosis. Infliximab（5mg/kg body weight）was administrated at 0,2, and 6 weeks and every 8 weeks thereafter.

　Seven of 8 patients who were treated with infliximab for induction therapy achieved remission and all of these patients remained in remission receiving scheduled treatments with infliximab. The longest duration of remission was about 6 years. One patient who had stricture and intestinal fistula in the anastomosis made no response and required surgical treatement. One patient who was treated with infliximab to prevent post operative recurrence has maintained remission. None of the patients had adverse effects due to possible toxicity of infliximab.

　Our results suggest that scheduled infliximab therapy is safe and useful for induction and maintaining remission of intestinal Behçet's disease and simple ulcer.