系统性审查:使用tacrolimus在类固醇耐药性性结肠炎
Vinay Jangra1,2, Dilsan Yilmaz3, Delvene Soares3
1Department of Colorectal Surgery, Barts Health NHS Trust, Whipps Cross Hospital, Whipps Cross Road, London E11 1NR, UK.
Therapeutic advances in chronic disease
|June 16, 2025
概括
塔克罗利木斯为耐固醇性性结肠炎 (SR-UC) 提供了潜在的治疗方法,显示与抗TNF药物相似的短期缓解,但具有不确定的长期结果和显著的副作用. 为了优化使用,需要进一步的研究.
科学领域:
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 类固醇耐药性性结肠炎 (SR-UC) 提出了重大管理挑战,往往需要超越皮质类固醇的先进疗法.
- 作为一种替代治疗方法,正在研究一种免疫调节性氨氨酸抑制剂塔克罗利,但其长期疗效和安全性需要彻底调查.
研究的目的:
- 系统地审查SR-UC患者中塔克罗利斯的疗效和安全性.
- 为了比较tacrolimus与抗瘤亡因子 (TNF) 药物在管理SR-UC.
- 评估tacrolimus在类固醇耐药性性直肠炎 (SR-UP) 中的作用.
主要方法:
- 系统审查遵循系统审查和元分析 (PRISMA) 准则的首选报告项目.
- 搜索了PubMed和Medline (1998-2025) 关于临床缓解,反应,不良事件和切除术率的研究.
- 在SR-UP中进行了小组分析,比较口服塔克罗利与抗TNF治疗以及局部塔克罗利.
主要成果:
- 分析了涉及658名患者的17项研究,揭示了塔克罗利斯的可变疗效 (缓解9.4%-75.6%).
- 副作用,主要是神经毒性和毒性,发生在16.7%-53.0%的病例中,胆管切除率从6.1%到62%不等.
- 塔克罗利莫斯的短期缓解诱导效果与抗TNF药物相比较,但抗TNF药物显示出更好的长期结果. 局部塔克罗利斯对SR-UP有效,但具有较高的不良事件率.
结论:
- 塔克罗利莫斯是SR-UC的可行的选择,特别是在组合治疗中,尽管长期的疗效和安全性需要进一步评估.
- 虽然可与抗TNFs进行短期缓解,但仔细监测不良反应和胆管切除率至关重要.
- 局部塔克罗利斯对SR-UP有希望,但需要标准化剂量和大规模试验来优化治疗和评估长期安全性.
相关概念视频
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
212
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...
212
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
278
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...
278
Drugs for Treatment of Ulcerative Colitis in IBD
244
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...
244
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
240
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...
240
Inflammatory Bowel Disease IV: Pharmacological Management
205
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...
205
Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents
709
In the intricate landscape of the gastric lumen, excessive acid secretion disrupts the natural defense mechanisms, weakening the mucus-bicarbonate barrier. This vulnerability allows pepsin to infiltrate epithelial cells, digesting mucosal proteins and triggering erosion, leading to ulcer formation.
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
709


