IFXによる重篤な副作用―感染症と皮膚病変

Adverse Events in Patients with Crohn's Disease Treated with IFX

要旨　Crohn病（CD）に対する高い効果を示すインフリキシマブ（IFX）であるが，副作用には注意が必要である．副作用は大きく分けて生物学的製剤であることに起因するもの（infusion reaction）とTNF-αの機能抑制に起因するもの（結核を中心とした感染症や心不全など）がある．infusion reactionはATIの産生と関連性があり，またepisodic投与で出現しやすくなる．欧米に比べ結核感染者数の多いわが国では，特に結核菌に注意が必要であり，より厳格に予防対策をとらなければならない．まれではあるが注意が必要な合併症に乾癬がある．再燃しやすく注意深い治療戦略が必要である．

　Infliximab shows efficacy in induction and maintenance of response and remission in treatment-refractory CD. Some adverse events（acute and delayed infusion reactions）are due to the nature of biologics itself, others（infectious diseases, heart failure and others）the result of suppression of TNF-α. Infusion reaction is associated with ATI formation and is more common in episodic treatment. In Japan, a history of TB exposure should be regarded more carefully and TB prevention procedures should be followed more strictly. The same applies to HBV. Psoriasis associated with anti-TNF therapy is uncommon, but should receive careful attention. Forty-three percent of the cases required definitive withdrawal of anti-TNF therapy due to recurrence of rash.