托法西替尼在急性严重性结肠炎 (TACOS):一个随机对照试验
Arshdeep Singh1, Manjeet Kumar Goyal1, Vandana Midha2
1Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
The American journal of gastroenterology
|December 22, 2023
概括
在急性严重性结肠炎 (ASUC) 患者中,添加托法西替尼 (tofacitinib) 于皮质类固醇显著改善了治疗反应. 这种组合疗法还减少了对救援药物的需求,为ASUC提供了更有效的治疗选择.
科学领域:
- 胃肠病学 胃肠病学
- 临床药理学 临床药理学
- 免疫学 免疫学 免疫学
背景情况:
- 静脉输入的皮质类固醇是急性严重性结肠炎 (ASUC) 的标准治疗方法.
- 很大一部分 (30%-40%) 的ASUC患者表现出皮质类固醇折射性.
- 对抗皮质类固醇耐药的ASUC.需要新的治疗策略.
研究的目的:
- 评估托法西提尼布与皮质类固醇联合治疗ASUC的疗效.
- 为了确定托法西替尼是否改善ASUC患者的治疗反应.
主要方法:
- 进行了一项单中心,双盲,安慰剂控制的试验.
- 成年ASUC患者接受托法西提尼布 (每天10毫克三次) 或安慰剂7天,以及静脉输入皮质类固醇.
- 治疗反应的定义是,在没有救援疗法的第7天,利希泰格指数显著下降.
主要成果:
- 接受托法西提尼布治疗的83.01%的患者获得治疗反应,而安慰剂治疗的58.82% (P=0.007).
- 在托法西提尼布组 (P=0.01) 中,到第7天需要救援治疗的需要显著降低 (P=0.01).
- 到第90天需要救援治疗的累积概率与托法西提尼布 (0.13对0.38,P=0.003) 显著降低.
结论:
- 托法西提尼布和皮质类固醇的联合治疗可以提高ASUC患者的治疗反应.
- 将托法西提尼布添加到皮质类固醇中,可以降低ASUC中的救援疗法的要求.
- 托法西提尼布是治疗急性严重性结肠炎的有希望的补充.
相关概念视频
Drugs for Treatment of Ulcerative Colitis in IBD
145
Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
145
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
168
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
168
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
141
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
141
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
121
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
121
Inflammatory Bowel Disease IV: Pharmacological Management
128
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
128
Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
334
Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
334


