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Inicio Gastroenterología y Hepatología Actualización en el tratamiento de la colitis ulcerosa
Información de la revista
Vol. 31. Núm. S4.
Jornada de Actualización en Gastroenterología Aplicada
Páginas 51-56 (octubre 2008)
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Vol. 31. Núm. S4.
Jornada de Actualización en Gastroenterología Aplicada
Páginas 51-56 (octubre 2008)
Jornada de actualización en gastroenterología aplicada
Acceso a texto completo
Actualización en el tratamiento de la colitis ulcerosa
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4030
Pilar Nos Mateu
Autor para correspondencia
nos_pil@gva.es

Correspondencia: Servicio de Medicina Digestiva. Hospital La Fe. Avda. Campanar, 21. 46009 Valencia. España.
Servicio de Medicina Digestiva. Hospital La Fe. Valencia. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Barcelona. España
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Resumen

En la DDW 2008, en lo referente a la colitis ulcerosa destaca que se han presentado los resultados preliminares de la administración de dexametasona encapsulada y administrada en perfusión intravenosa, con resultados muy prometedores en eficacia y seguridad para los pacientes que precisan corticoides. Los datos sobre aminosalicilatos apuntan a las ventajas, porque facilitan una mejor adherencia, de un menor número de administraciones al día tanto en la inducción de la remisión como en el tratamiento de mantenimiento, ya sea en adminitración oral o en forma de supositorios. Respecto a los inmunosupresores tiopurínicos, se han aportado datos sobre su farmacocinética y, especialmente, sobre su perfil de seguridad. Las aportaciones sobre fármacos biológicos, anti-TNF (factor de necrosis tumoral), han sido las derivadas de los subanálisis de los estudios pivotales ACT. Respecto a nuevos tratamientos, se han presentado los resultados sobre la eficacia de los probióticos (VSL#3) en la inducción de remisión, asociados a los salicilatos.

Palabras clave:
Enfermedad inflamatoria intestinal
Colitis ulcerosa
Tratamiento
Abstract

The present article reports highlights on the treatment of ulcerative colitis presented at Digestive Disease Week 2008. On the basis of the preliminary results presented, intravenous infusion of encapsulated dexamethasone may help to improve outcomes, both in terms of efficacy and toxicity in patients requiring steroids. Once-daily dosing of 5-ASA/mesalamine is likely to be well received by patients now that this dosing regimen appears to be as effective as multiple daily dosing both in inducing remission and as maintenance therapy, whether administered orally or as a suppository. New data on the pharmacokinetics and toxicity of immunosuppressive agents and data extracted from the pivotal ACT studies (infliximab for ulcerative colitis) were presented. Among the newer agents in the pipeline, a probiotic preparation (VSL#3) may prove helpful in inducing remission in patients with ulcerative colitis associated with 5-ASA.

Key words:
Inflammatory bowel disease
ulcerative colitis
therapy
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Bibliografía
[1.]
G.R. Lichtenstein, M.T. Abreu, R. Cohen, W. Tremaine.
American Gastroenterological Association Institute medical position statement on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease.
Gastroenterology, 130 (2006), pp. 935-939
[2.]
S.P.L. Travis, E.F. Stange, M. Lémann, Øresland., W.A. Bemelman, Y. Chowers, et al.
European evidence-based consensus on the management of ulcerative colitis: current management.
J Crohn's Colitis, 2 (2008), pp. 24-62
[3.]
P. Rutgeerts, W.J. Sandborn, B.G. Feagan, W. Reinisch, A. Olson, J. Johanns, et al.
Infliximab for induction and maintenance therapy for ulcerative colitis.
N Engl J Med, 353 (2005), pp. 2462-2476
[4.]
P.J. Rutgeerts.
Review article: the limitations of corticosteroid therapy in Crohn's disease.
Aliment Pharmacol Ther, 15 (2001), pp. 1515-1525
[5.]
G.R. Lichtenstein, B.G. Feagan, R.D. Cohen, B.A. Salzberg, R.H. Diamond, D.M. Chen, et al.
Serious infections and mortality in association with therapies for Crohn's disease: TREAT registry.
Clin Gastroenterol Hepatol, 4 (2006), pp. 621-630
[6.]
F. Bossa, A. Latiano, L. Rossi, M. Magnani, O. Palmieri, B. Dallapiccola, et al.
Erythrocytes-mediated delivery of low doses of dexamethasone revert steroid-dependency in ulcerative colitis: A double-blind, sham-controlled study.
Gastroenterology, 134 (2008), pp. A117
[7.]
G. D’Haens, J.F. Colombel, D.W. Wommes, J. Panés, P. Rutgeerts, A. Ekbom, et al.
Corticosteroids pose an increased risk for serious infection: An interim safety analysis of the ENCORE Registry.
Gastroenterology, 134 (2008), pp. A140
[8.]
G.T. Ho, M. Hudson, H.M. Lee, W.H. Han, T. Ting, P.P. Chiam, et al.
The efficacy of corticosteroid therapy: Analysis of 10-year inflammatory bowel disease inception cohort (1998-2007).
Gastroenterology, 134 (2008), pp. A155
[9.]
P. Munkholm, E. Langholz, M. Davidsen, V. Binder.
Frequency of glucocorticoid resistance and dependency in Crohn's disease.
Gut, 35 (1994), pp. 360-362
[10.]
W.A. Faubion, E.V. Loftus, W.S. Harmsen, A.R. Zinsmeister, W.J. Sandborn.
The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study.
Gastroenterology, 121 (2001), pp. 255-260
[11.]
O.K. Bonderup, J.B. Hansen, P.S. Teglbjaerg, L.A. Christensen, J.F. Faillingborg.
Long-term budesonide treatment of collagenous colitis: A randomized, double-blind, placebo-controlled trial.
Gastroenterology, 134 (2008), pp. A487-A488
[12.]
S. Miehlke, A. Madisch, B. Bethke, A. Morgner, G. Baretton, M. Stolte.
Oral budesonide for maintenance treatment of collagenous colitis: A randomized, placebo-controlled, double-blind trial.
Gastroenterology, 134 (2008), pp. A488-A489
[13.]
S.V. Kane, R.D. Cohen, J.E. Aikens, S.B. Hanauer.
Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis.
Am J Gastroenterol, 96 (2001), pp. 2929-2933
[14.]
W.J. Sandborn, J. Regula, B. Feagan, E.A. Belousova, N.V. Jojic, M. Lukas, et al.
Efficacy and safety of delayed-release oral mesalamine at 4.8g/day (800mg tablet) in the treatment of moderately active ulcerative colitis: Results of the Ascend III study.
Gastroenterology, 134 (2008), pp. A99
[15.]
S.B. Hanauer, W.J. Sandborn, A. Kornbluth, S. Katz, M. Safdi, S. Woogen, et al.
Delayed-release oral mesalamine at 4.8 g/day (800 mg tablet) for the treatment of moderately active ulcerative colitis: the ASCEND II trial.
Am J Gastroenterol, 100 (2005), pp. 2478-2485
[16.]
S.B. Hanauer, W.J. Sandborn, C. Dallaire, A. Archambault, B. Yacyshyn, C. Yeh, et al.
Delayed-release oral mesalamine 4.8 g/day (800 mg tablets) compared to 2.4 g/day (400 mg tablets) for the treatment of mildly to moderately active ulcerative colitis: The ASCEND I trial.
Can J Gastroenterol, 21 (2007), pp. 827-834
[17.]
W.J. Sandborn, M.A. Kamm, G.R. Litchtenstein, A. Lyne, T. Butler, R.E. Joseph.
MMX Multi Matrix System mesalazine for the induction of remission in patients with mild-to-moderate ulcerative colitis: a combined analysis of two randomized, double-blind, placebo-controlled trials.
Aliment Pharmacol Ther, 26 (2007), pp. 205-215
[18.]
G.R. Lichtenstein, M.A. Kamm, W.J. Sandborn, A. Lyne, R.E. Joseph.
MMX mesalazine for the induction of remission of mild-to-moderately active ulcerative colitis: efficacy and tolerability in specific patient subpopulations.
Aliment Pharmacol Ther, 27 (2008), pp. 1094-1102
[19.]
C. Prantera, M.L. Scribano, S. Franchini, S. Bellinvia.
Once daily MMX(R) 5-aminosalicylic acid (2.4g/day) has a similar safety profile to twice-daily Asacol(R) delayed-release tablets (2.4g/day): Results of a superiority trial for the maintenance of remission of ulcerative colitis.
Gastroenterology, 134 (2008), pp. A495
[20.]
W. Kruis, L. Jonaitis, J. Pokrotnieks, et al.
Once daily 3g mesalamine is the optimal dose for maintaining clinical remission in ulcerative colitis: A double-blind, double-dummy, randomized controlled, dose-ranging.
Gastroenterology, 134 (2008), pp. A489
[21.]
T. Andus, A. Klocjan, M. Muser, et al.
A novel high dose 1g mesalamine suppository (Salofalk[R]) is as efficacious as 500mg TID suppositories in mild to moderate active ulcerative proctitis: a multicenter randomized trial.
Gastroenterology, 134 (2008), pp. A491
[22.]
M. Reinshagen, E. Schütz, V.W. Armstrong, C. Behrens, C. Von Tirpitz, A. Stallmach, et al.
6-thioguanine nucleotide-adapted azathioprine therapy does not lead to higher remission rates than standard therapy in chronic active crohn disease: results from a randomized, controlled, open trial.
Clin Chem, 53 (2007), pp. 1306-1314
[23.]
L.Y. Kwan, S.M. Devlin, J.M. Mirocha, K.A. Papadakis.
Thiopurine methyltransferase activity combined with 6-thioguanine metabolite levels predicts clinical response to thiopurines in patients with inflammatory bowel disease.
Dig Liver Dis, 40 (2008), pp. 425-432
[24.]
J.P. Gisbert.
6-Thioguanine Nucleotide (6-TGN) Concentrations and efficacy of azathioprine (AZA) and mercaptopurine (Mp) in inflammatory bowel disease: the Metaza Study.
Gastroenterology, (2008), pp. 134
[25.]
Y. Gonzalez-Lama.
Utility of azathioprine metabolites determination during follow up of inflammatory bowel disease patients after steroid treatment withdrawal.
Gastroenterology, 134 (2008), pp. S1250
[26.]
B. Jharap, N. De Boer, C.J. Van der Woude, D.W. Hommes, P.C. Stokkers, D.J. De Jong, et al.
Thiopurine metabolite measurements during pregnancy in mother and child.
Gastroenterology, 134 (2008), pp. A69
[27.]
P.D. Graaf, N. De Boer, B. Jharap, C.J. Mulder, A.A. Bodegraven, Schawab., et al.
Alteration of thiopurine phosphate metabolite levels by aminosalicylates in IBD patients.
Gastroenterology, 134 (2008), pp. A69-A70
[28.]
J.D. Lewis, J.M. Gelfand, A.B. Troxel, K.A. Forde, C. Newcomb, H. Kim, et al.
Immunosuppressant medications and mortality in inflammatory bowel disease.
Gastroenterology, 134 (2008), pp. A144
[29.]
M. Setshedi, D. Epstein, R. Hift, et al.
Risk of malignancy in patients with inflammatory bowel disease treated with azathioprine or 6-mercaptopurine. The Cape Town experience.
Gastroenterology, 134 (2008), pp. A140-A141
[30.]
L. Beaugerie, F. Carrat, A.M. Bouvier, N. Brousse, F. Carbonnel, J.F. Colombel, et al.
Excess risk of lymphoproliferative disorders (LPD) in inflammatory bowel diseases (IBD): interim results of the Cesame cohort.
Gastroenterology, 134 (2008), pp. A116-A117
[31.]
S.B. Shah, N.K. Parekh, S.B. Hanauer, R.D. Cohen.
Intravenous cyclosporine in severe steroid-refractory ulcerative colitis: Longterm follow-up.
Gastroenterology, 134 (2008), pp. A155
[32.]
D.H. Present, W.J. Sandborn, P. Rutgeerts, A. Olson, R.H. Diamond, J.R. Johanns, et al.
Infliximab treatment for ulcerative colitis: clinical response, clinical remission, and mucosal healing in patients with moderate or severe disease in the active ulcerative colitis trials (ACT1 & ACT2).
Gastroenterology, 134 (2008), pp. T1142
[33.]
W. Reinisch, W.J. Sandborn, P. Rutgeerts, M. Blank, A. Olson, et al.
Infliximab treatment for ulcerative colitis: comparable clinical response, clinical remission, and mucosal healing in patients with disease duration < 3 years vs = 3 years.
Gastroenterology, 134 (2008), pp. T1153
[34.]
W.J. Sandborn, P. Rutgeerts, B. Feagan, W. Reinisch, A. Olson, J.R. Johanns, et al.
The ACT Trials: incremental benefit of second and third induction doses of infliximab in patients with moderately-to-severely active ulcerative colitis (UC).
Gastroenterology, 134 (2008), pp. T1139
[35.]
A. Papa, I. De Vitis, L. Guidi, F. Aiello, G. Brandimarte, W. Elesei, et al.
Mucosal healing in ulcerative colitis patients in longterm therapy with infliximab.
Gastroenterology, 134 (2008), pp. S1245
[36.]
M. Barreiro, A. Lorenzo, J. Mera, E. Dominguez-Muñoz.
Prospective, open pilot study for evaluating the clinical efficacy and mucosal healing rate of infliximab in steroid-dependent ulcerative colitis.
Gastroenterology, 134 (2008), pp. W1262
[37.]
G.K. Makharia, A. Sood, V. Midha, V. Ahuja, D.K. Singal, R. Arora, et al.
A randomized, double-blind, placebo-controlled trial of a probiotic preparation, VSL#3, for the treatment of mild to moderate active ulcerative colitis.
Gastroenterology, 134 (2008), pp. A99
[38.]
E. Miele, R. Baldassano, F. Pascarella, E. Giannetti, R. Troncone, A. Staiano.
Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis.
Gastroenterology, 134 (2008), pp. A153
[39.]
A. Esmaeili, M. Masjedi, A. Ani, Z. Farajzadegan, A. Behbahani, M. Dashti, et al.
New insights of anti-depressant therapy in the management of ulcerative colitis.
Gastroenterology, 134 (2008), pp. A100
[40.]
W. Stremmel, A. Braun, A. Hanemann, F. Autshchbach, R. Ehehalt, M. Karner.
Retarded release phosphatidylcholine in non-steroidtreated ulcerative pancolitis: a randomized, controlled dose-finding study.
Gastroenterology, 134 (2008), pp. A100
Copyright © 2008. Elsevier España S.L.. Todos los derechos reservados
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