当科でのタクロリムス投与の短期成績

抄録

    The outcomes of tacrolimus therapy were evaluated in20patients who received the drug for 6 months or more before October 2007. The study focused on analysis of the background variables and evaluation of the drug efficacy according to the EULAR Response Criteria based on DAS28-CRP.
    The mean age of the patients was 70 years and the mean duration of sickness was 18.4 years. The disease stage was I in 2 cases, Ⅱ in 2 cases, Ⅲ in4cases and Ⅳ in 12 cases. The disease class was 2 in 13 cases, 3 in 4 cases and 4 in 3 cases; thus, the disease tended to be advanced in the majority. The mean steroid dose was 5.6 mg/day. The number of antirheumatic drugs used was 2.3, on average. Tacrolimus was often used in elderly patients and patients in whom MTX administration was difficult because of respiratory complications. The pre-treatment DAS28-CRP score was 4.1, on average (corresponding to moderate or higher activity). Moderate or better improvement was noted in 14 (70％) of the 20 cases. Adverse reactions noted were constipation (2 cases), bacterial pneumonia (1 case), cystitis (1 case) and subcutaneous abscess (1 case). Renal dysfunction was found in3cases, with recovery noted after dose reduction. Drug level monitoring to maintain optimal levels improved the therapeutic outcome. None of these necessitated discontinuation of tacrolimus. These results suggest that tacrolimus may serve as a useful drug for treating rheumatoid arthritis in elderly patients and patients in whom MTX administration might be difficult because of respiratory complications, etc.