Digestive Disease Week (DDW) は米国の消化器関連学会が一堂に会する非常に規模の大きな学会です。

我々は「Therapeutic effects and adverse events of tacrolimus on patients with Crohn’s disease: A systematic review and meta-analysis」というタイトルで、Poster発表を行いました。仲瀬教授と東京大学の野島准教授に御指導をいただいて、このような場で発表をすることが出来ました。あとは論文が通れば嬉しいのですが。。。

来年はSan Diegoにて開催されるとのことですが、次はもう少しまともな英語を話せるように、そして後輩と一緒に来ることが出来るように、日々努力していきたいと思います。

本発表に際し、御世話になった全ての方に深謝致します。

Background and Aim: There are evidences showing that tacrolimus (TAC) could be useful for induction of remission for patients with ulcerative colitis. However, evidence regarding the efficacy and adverse events of TAC for patients with active Crohn’s disease (CD) is few. The aim of this study is to conduct a systematic review with meta-analysis on therapeutic effects and adverse events of TAC for patients with CD.
Methods: We investigated the studies which were reported therapeutic effects and adverse events of TAC for patients with CD from 1950 until June 2017 in PubMed, Embase, Web of Science and the Cochrane Library. The following MeSH were used: “Inflammatory bowel disease” AND “Crohn’s disease OR CD” AND “tacrolimus OR FK OR FK506” AND “calcineurin inhibitor”. Study subjects were categorized and analyzed by 3 groups; systemic administration of TAC for patients with luminal CD (Study 1), systemic administration of TAC for patients with perianal CD (Study 2), and topical administration of TAC for patients with localized CD (Study 3). Clinical response as well as clinical remission were studied. Additionally, factors related to remission and incidence of adverse events were studied. These were conducted by a specialist of medical statistics.
Results: 15 out of 109 publications were considered to be eligible for inclusion in this analysis. Finally, 9, 6, and 3 out of 109 publications were included in the analysis in Study 1, 2, and 3, respectively. The clinical response rate of Study 1, 2, and 3 was 83.9%, 59.2%, and 80.6%, respectively. The clinical remission rate of those was 37.5%, 28.6%, and 19.4%, respectively. In study 1, it showed an inverse correlation between clinical remission by TAC therapy and previous anti-TNFα treatments (R= -0.883). Remission rate in cases with previous anti-TNFα treatments was speculated as 20.5%, and that in cases without previous anti-TNFα treatments was speculated as 75.8%. The incidence of adverse events of three studies was 52.9%, 78.0%, and 40.0%, respectively. Serious adverse events did not occur in any studies.
Conclusions: This systematic review and meta-analysis showed the efficacy and safety of TAC therapy for patients with CD. TAC therapy is a valid therapeutic alternative for induction of clinical improvement for patients with active CD, and the incidence of adverse event was tolerable. In addition, we found that the efficacy of TAC therapy for patients in anti-TNFα naïve was higher than those who failed anti-TNFα treatments. Therefore, TAC therapy is considered as one of the options for patients with active CD. However, well-designed randomized control trial is few, and the long-term efficacy of TAC therapy for patients with CD remains unclear. Further studies are required to determine the efficacy and safety of TAC therapy for patients with active CD.