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Managing the glucocorticoid dependent inflammatory bowel disease patient
1Department of Gastroenterology, Cleveland Clinic Florida, Weston 33331, USA. bonnerg@ccf.org
Seminars in Gastrointestinal Disease
|December 1, 2001
Summary
Glucocorticoids are standard for inflammatory bowel disease but have side effects. Alternative medications like azathioprine, 6-mercaptopurine, and infliximab offer less toxic options for managing Crohn's disease and ulcerative colitis.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Standard therapy for inflammatory bowel disease (IBD) involves glucocorticoids for moderate to severe Crohn's disease and ulcerative colitis.
- While effective for many, glucocorticoids carry significant side effects, necessitating alternative treatments.
Observation:
- A notable portion of patients experience disease flares when attempting to discontinue glucocorticoids.
- Identifying safer, long-term treatment options is crucial for managing IBD patients.
Findings:
- Azathioprine and 6-mercaptopurine are established, reliable alternatives.
- Infliximab shows promise for glucocorticoid tapering in Crohn's disease.
- Methotrexate, budesonide, and CDP571 are other potential therapeutic options for IBD.
Implications:
- Switching patients from glucocorticoids to less toxic medications can improve long-term outcomes and reduce adverse effects.
- Further research into newer agents like budesonide and CDP571 may expand therapeutic options for IBD.
- Personalized treatment strategies considering drug efficacy and toxicity are essential for IBD management.