Role of Topical Tacrolimus in the Management of Proctitis, Perianal Manifestations in Crohn's Disease, and Chronic Pouchitis: A Systematic Review
| Autor: | George Salem, Kai Ding, Atsushi Sakuraba, Russell D. Cohen |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Crohn's disease
medicine.medical_specialty business.industry medicine.medical_treatment General Medicine Enema Pouchitis medicine.disease Dermatology Inflammatory bowel disease General Biochemistry Genetics and Molecular Biology Tacrolimus 03 medical and health sciences surgical procedures operative 0302 clinical medicine Rectal administration medicine 030211 gastroenterology & hepatology 030212 general & internal medicine Adverse effect business Proctitis |
| Zdroj: | Journal of Investigative Medicine. 69:796-803 |
| ISSN: | 1708-8267 1081-5589 |
| DOI: | 10.1136/jim-2020-001699 |
| Popis: | Several published studies have evaluated the safety and effectiveness of oral and intravenous tacrolimus for the management of patients with inflammatory bowel disease (IBD). However, little is known about the effectiveness of topical tacrolimus in this patient population. The aim of this systematic review was to evaluate the current state of literature to evaluate the safety and effectiveness of rectal administration of topical tacrolimus, in the form of suppository, ointment, and/or enema in patients with ulcerative proctitis, perianal Crohn's disease (CD), and chronic refractory pouchitis. Electronic database searches were conducted in international databases since their inception until February 2020. Study subjects were categorized into three groups: topical tacrolimus for patients with proctitis, perianal CD, and chronic refractory pouchitis. The primary end point of this study was the remission rate. Secondary end points were response rate and the incidence of AEs. Eleven studies were included in the final assessment in this systematic review. This provided information from 188 patients. Tacrolimus was administered topically as suppositories, ointment, or enema. Clinical remission was achieved in 57.1%, 57.14%, and 70.0% in patients with proctitis, fistulizing perianal CD, and chronic pouchitis. The most commonly reported side effect was perianal itching and burning. Reversible nephrotoxicity occurred in a single patient. No clear correlation was found between blood levels and clinical outcomes. Topical tacrolimus is effective for a subset of patients with IBD. The adverse effects were minimal and tolerable. Well-designed randomized clinical trials are warranted to establish the appropriate dose and administration method. |
| Databáze: | OpenAIRE |
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