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Optimizing drug therapy in inflammatory bowel disease
Arun Swaminath1, Asher Kornbluth
1Henry D. Janowitz Division of Gastroenterology, Mount Sinai School of Medicine, 1425 Madison Avenue, Box 1069, New York, NY 10029, USA. Arun.Swaminath@mssm.edu
Current Gastroenterology Reports
|April 2, 2008
Summary
This review optimizes inflammatory bowel disease drug use, clarifying steroid dosing for severe ulcerative colitis (UC) and suggesting higher mesalamine doses for moderate UC. It also discusses cyclosporine, thiopurines, and anti-TNF therapies.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Optimizing drug therapy is crucial for managing inflammatory bowel disease (IBD).
- Current data on established and novel IBD medications require synthesis for clinical application.
Purpose of the Study:
- To review and synthesize current data for optimizing the use of older and newer drugs in inflammatory bowel disease management.
- To provide evidence-based recommendations for drug selection and dosing in ulcerative colitis (UC) and Crohn's disease.
Main Methods:
- Comprehensive literature review of recent studies on IBD pharmacotherapy.
- Analysis of data on steroid dosing, mesalamine formulations, cyclosporine outcomes, thiopurine metabolite testing, and anti-tumor necrosis factor (anti-TNF) therapy.
Main Results:
- Steroid dosing strategies for severe UC have been clarified, with reported outcomes and toxicities.
- Higher doses of pH-dependent release mesalamine may benefit moderate UC; a once-daily MMX formulation is approved.
- Long-term follow-up of cyclosporine A for UC indicates a potential increase in colectomy rates.
- New information on thiopurine metabolite testing and therapy duration is available.
- Accumulating data guides optimal use of anti-TNF therapies.
Conclusions:
- Evidence supports refined dosing for steroids and mesalamine in UC.
- Cyclosporine use in UC warrants careful consideration due to long-term colectomy risk.
- Thiopurine and anti-TNF therapy optimization relies on metabolite testing and accumulating evidence.
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