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Intestinal Research ; : 218-226, 2019.
Article in English | WPRIM | ID: wpr-764137


BACKGROUND/AIMS: The pharmacokinetics of tacrolimus (TAC) is known to be largely influenced by single-nucleotide polymorphisms (SNPs) in CYP3A5. Patients starting TAC require careful dose adjustment, owing to the wide range of optimal dosages, depending on their CYP3A5 expression status. Here, we evaluated whether individualization of TAC dosages based on CYP3A5 SNPs would improve its therapeutic efficacy in ulcerative colitis. METHODS: Twenty-one patients were prospectively treated, with their initial dosage adjusted according to their CYP3A5 status (0.1, 0.15, and 0.2 mg/kg/day for CYP3A5*3/*3, CYP3A5*1/*3, and CYP3A5*1/*1, respectively). Their clinical outcomes were compared with those of patients treated with a fixed dose (0.1 mg/kg/day). RESULTS: The first blood trough level of CYP3A5 expressors, CYP3A5*1/*3 or CYP3A5*1/*1, and the overall rate in achieving the target blood trough level within a week in the individualized-dose group were significantly higher than those in the fixed-dose group (5.15±2.33 ng/mL vs. 9.63±0.79 ng/mL, P=0.035 and 12.5% vs. 66.7%, P=0.01). The remission rate at 2 weeks in the expressors was as high as that in the nonexpressors, CYP3A5*3/*3, in the individualized-dose group. CONCLUSIONS: Individualized TAC treatment is effective against ulcerative colitis regardless of the CYP3A5 genotype.

Humans , Colitis, Ulcerative , Cytochrome P-450 CYP3A , Genotype , Pharmacokinetics , Polymorphism, Single Nucleotide , Prospective Studies , Tacrolimus , Ulcer
Intestinal Research ; : 87-93, 2019.
Article in English | WPRIM | ID: wpr-740027


BACKGROUND/AIMS: Oral mesalazine is an important treatment for ulcerative colitis (UC), and non-adherence to mesalazine increases the risk of relapse. Controlled-release (CR) mesalazine has 2 formulations: tablets and granules. The relative acceptabilities of these formulations may influence patient adherence; however, they have not been compared to date. This study aimed to evaluate the acceptabilities of the 2 formulations of CR mesalazine in relation to patient adherence using a crossover questionnaire survey. METHODS: UC patients were randomly assigned to 2 groups in a 1:1 ratio. Patients in each group took either 4 g of CR mesalazine tablets or granules for 6 to 9 weeks, and then switched to 4 g of the other formulation for a further 6 to 9 weeks. The acceptability and efficacy were evaluated by questionnaires, and adherence was assessed using a visual analog scale. The difference in acceptabilities between the 2 formulations and its impact on adherence were assessed. RESULTS: A total of 49 patients were prospectively enrolled and 33 patients were included in the analysis. Significantly more patients found the tablets to be less acceptable than the granules (76% vs. 33%, P=0.0005). The granules were preferable to the tablets when the 2 formulations were compared directly (73% vs. 21%, P=0.004), for their portability, size, and numbers of pills. The adherence rate was slightly better among patients taking the granules (94% vs. 91%) during the observation period, but the difference was not significant (P=0.139). CONCLUSIONS: CR mesalazine granules are more acceptable than tablets, and may therefore be a better option for long-term medication.

Humans , Colitis, Ulcerative , Drug Compounding , Medication Adherence , Mesalamine , Patient Acceptance of Health Care , Patient Compliance , Prospective Studies , Recurrence , Tablets , Ulcer , Visual Analog Scale
Intestinal Research ; : 535-539, 2017.
Article in English | WPRIM | ID: wpr-220092


Extracolonic involvement of the gastrointestinal tract is extremely uncommon in ulcerative colitis (UC) and rarely found in the upper gastrointestinal tract or in postoperative cases since it typically responds to steroids. Here we report a case of UC complicated by extensive ileal inflammation that was refractory to steroids. A 20-year-old man was diagnosed with UC of typical pancolitis without ileal involvement and started treatment with pH-dependent mesalazine and oral prednisolone. Although his symptoms transiently resolved, the condition flared when the steroid dose was tapered down. Computed tomography revealed marked thickening of the ileal wall, and capsule endoscopy and balloon-assisted enteroscopy found diffuse mucosal inflammation with ulcers in the ileum. On the contrary, the inflammation in the colon and rectum was improving. Since the response to the second steroid course was inadequate, treatment with adalimumab and 6-mercaptopurine was initiated and finally achieved clinical and endoscopic remission. The investigation of small intestinal lesions is necessary in patients with UC whose clinical deterioration cannot be explained by colonic lesions.

Humans , Young Adult , Mercaptopurine , Adalimumab , Capsule Endoscopy , Colitis, Ulcerative , Colon , Enteritis , Gastrointestinal Tract , Ileum , Inflammation , Inflammatory Bowel Diseases , Mesalamine , Prednisolone , Rectum , Steroids , Ulcer , Upper Gastrointestinal Tract
Article in English | WPRIM | ID: wpr-379131


The purpose of this study was to investigate the intensity of exercise load which increases urinary 8-hydroxydeoxyguanosine (8-OHdG) excretion and the effect of antioxidant supplementation on urinary 8-OHdG excretion after a single bout of exercise. The subjects included 6 healthy males with the following characteristics : age ; 24.0±1.1 years, height ; 174.0±8.5 cm, weight ; 71.5±15.4 kg, BMI ; 23.2±3.4 kg/m<sup>2</sup>. The urinary concentration of 8-OHdG was measured by the two-column-switching high-performance liquid chromatography (HPLC) method. After 7 days of supplementation, the time course of the urinary 8-OHdG excretion was observed following treadmill running at 70% VO<sub>2</sub>max.Significant increases in the urinary 8-OHdG excretion were detected at 2 h (p<0.01) and 4 h (p<0.05) after exercise.After 7 days of supplementation, a significant increase in the urinary 8-OHdG excretion was detected 1 h after exercise (p<0.05); however, it returned to the initial level 2 h after exercise. Therefore, oxidative DNA damage induced by a single bout of exercise was diminished by antioxidant supplementation.