tailieunhanh - INFLAMMATORY BOWEL DISEASE - PART 5

Trong thử nghiệm kiểm soát, ngẫu nhiên, mù đôi, dùng giả dược trong 71 bệnh nhân steroid phụ thuộc vào CD, điều trị với CDP571 (20 mg / kg ở tuần 0 tiếp theo 10 mg / kg ở tuần 8) kết quả rút steroid hoàn thành bởi 16 tuần trong 44% bệnh nhân so với 22% bệnh nhân được điều trị | 142 Hecht Su and Lichtenstein to those seen with placebo. In a larger randomized double-blind placebo-controlled trial in 71 patients with steroid-dependent CD treatment with CDP571 20 mg kg at wk 0 followed by 10 mg kg at wk 8 resulted in complete steroid withdrawal by 16 wk in 44 of the patients compared to 22 of the patients treated with placebo p 42 . Once complete steroid withdrawal was achieved an open-label extension of that trial showed an 87 success rate of maintaining steroid withdrawal after 6 mo. CDP571 appears to be effective in inducing clinical response but not clinical remission after 2 wk of treatment and the optimal dose is 10 mg kg. CDP571 also may be effective in the treatment of CD complicated by fistulas. No comparisons between this agent and infliximab have yet been undertaken. As an agent for ulcerative colitis an uncontrolled trial of CDP571 in 15 patients with UC produced only modest improvement. Etanercept Enbrel is a human fusion protein combining the Fc portion of IgG with the ligand-binding portion of the TNF-a receptor with the resultant effect of inactivating TNF-a. Although some promise was seen for this agent in a small pilot study of Crohn s patients a subsequent larger placebo-controlled trial found no benefit of the drug when compared to placebo 43 . Thalidomide Despite its notorious teratogenic effect in the 1950s thalidomide has recently received revived attention as a therapeutic agent in CD because of its recently discovered inhibitory action on TNF-a production. Two recent small open-labeled trials suggest its possible benefit in CD. Treatment with thalidomide of variable doses 50 mg d to 300 mg d for 12 wk resulted in a response rate ranging from 64 to 70 in steroiddependent CD patients with moderately to severely active disease 44 45 . Thalidomide therapy also appears to have a favorable effect on fistulous diseases. A preliminary report of a small trial suggested this agent might be effective for patients with .