1例对英夫利西单抗失应答肛瘘型克罗恩病患者的病例分析

Loss of response to infliximab in patients with perianal fistulizing Crohn’s disease:a case report

1例反复发作的难治性肛瘘型克罗恩病患者使用英夫利西单抗出现继发性失应答,经治疗药物监测,联合硫唑嘌呤及剂量强化后仍无法达到预期治疗目标。临床药师参与其个体化药物治疗及监护过程,参考相关指南与文献后,对英夫利西单抗失应答的危险因素及原因进行分析,建议转换方案首选乌司奴单抗。治疗过程中,除了临床药师协助医师制定药物治疗方案,同时进行疗效和不良反应监护与随访,用药12周后患者粪便钙卫蛋白和C反应蛋白明显下降且实现瘘管愈合。本文可为类似复杂肛瘘型克罗恩病患者经优化治疗后英夫利西单抗仍失应答的方案调整提供用药参考。

A refractory Crohn's disease patient with recurrent perianal fistulas failed to overcome the secondary loss of response to infliximab(IFX)after therapeutic drug monitoring,intensified anti-TNF dosing and in combination with azathioprine.Throughout the treatment process,clinical pharmacists assisted physicians in analyzing the risk factors and causes for loss of response,providing evidence for an individualized treatment strategy,and monitoring the efficacy and safety of the treatment.According to the relevant guidelines and literature,ustekinumab was the preferred biological agent after anti-TNF failure in perianal fistulizing Crohn’s disease(pfCD).At the 12-week follow-up,fecal calprotectin and C-reactive protein decreased markedly,and the patient achieved fistula healing.This case provides references for current management strategy and perspective in IFX secondary non-responders with refractory pfCD,especially those who have undergone optimization therapy.