通过托法西提尼布成功治疗耐药性免疫介导性结肠炎和十二指肠炎
Noboru Misawa1, Takuma Higurashi1, Kojiro Inoue1
1Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
Case reports in gastroenterology
|October 9, 2025
概括
托法西替尼有效治疗由免疫检查点抑制剂 (ICI) 诱导的耐药性免疫媒介性结肠炎 (IMC). 这种Janus激酶抑制剂导致了对标准治疗无反应的患者的症状缓解和粘膜愈合.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 胃肠病学 胃肠病学
背景情况:
- 免疫介导性结肠炎 (IMC) 是一种与免疫检查点抑制剂 (ICI) 相关的显著免疫相关的不良事件.
- 像皮质类固醇和生物制剂这样的标准治疗方法并不总是有效,导致耐火病例.
- 氏激酶抑制剂,如托法西提尼布,显示出治疗耐火性IMC的潜力,但临床证据有限.
研究的目的:
- 报告一例耐火 pembrolizumab 诱导的 IMC 和十二指肠炎.
- 评估托法西提尼布在耐火性IMC和十二指肠炎患者的疗效.
- 突出托法西提尼布在管理严重免疫相关不良事件中的潜在作用.
主要方法:
- 一名患有布洛利祖马布诱导的IMC和对皮质类固醇,因弗力西马布和维多利祖马布耐药的十二指肠炎的患者接受了治疗.
- 进行了30天的托法西提尼布疗程.
- 评估了临床结果,包括症状缓解和粘膜愈合.
主要成果:
- 托法西替尼治疗导致症状迅速消失和粘膜完全愈合.
- 在停止托法西提尼布治疗三个月后,没有观察到大肠炎的复发.
- 患者耐受托法西提尼布很好,没有显著的不良事件.
结论:
- 托法西提尼布可以成为耐药性免疫介导性大肠炎和由免疫检查点抑制剂诱导的十二指肠炎的有效治疗选择.
- 需要进一步的临床研究来确定托法西提尼布在控制ICI诱导毒性的最佳剂量和长期疗效.
- 越来越多的ICI使用需要探索新的治疗策略来管理与免疫相关的不良事件.
相关概念视频
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
488
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...
488
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
490
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...
490
Drugs for Treatment of Ulcerative Colitis in IBD
456
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...
456
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
434
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...
434
Inflammatory Bowel Disease IV: Pharmacological Management
517
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...
517
Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
637
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...
637


