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Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
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Published on: November 8, 2015

Corticosteroid-sparing agents: conventional systemic immunosuppressants.

Jonathan Kruh1, C Stephen Foster

  • 1Massachusetts Eye Research and Surgery Institution, Ocular Immunology and Uveitis Foundation, Cambridge, Mass., USA. jkruh@mersi.com

Developments in Ophthalmology
|April 21, 2012
PubMed
Summary

Corticosteroids revolutionized eye disease treatment but caused side effects. Newer immunosuppressants offer corticosteroid-sparing options, improving long-term outcomes for inflammatory conditions.

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Published on: August 12, 2017

Area of Science:

  • Ophthalmology
  • Immunology
  • Pharmacology

Background:

  • Corticosteroids transformed inflammatory eye disease management.
  • Long-term corticosteroid use led to significant patient morbidity.
  • This necessitated the development of alternative immunosuppressive agents.

Purpose of the Study:

  • To review the role and classification of immunosuppressive agents in managing inflammatory eye diseases.
  • To highlight the shift towards corticosteroid-sparing therapies.
  • To emphasize the importance of a multifactorial approach in selecting immunosuppressants.

Main Methods:

  • Categorization of immunosuppressive agents by mechanism of action: alkylating, antimetabolite, and antibiotic/calcineurin inhibitors.
  • Discussion of the clinical application of these agents in systemic inflammatory diseases with ocular involvement.
  • Emphasis on the decision-making process for initiating therapy.

Main Results:

  • Immunosuppressive agents inhibit lymphoid proliferation and form the basis of modern corticosteroid-sparing therapy.
  • These agents are increasingly used as first-line treatment for severe inflammatory diseases like Behçet's disease and granulomatosis with polyangiitis.
  • A multidisciplinary approach involving ophthalmologists and other specialists is crucial for effective management.

Conclusions:

  • Immunomodulatory agents are foundational in corticosteroid-sparing immunosuppressive therapy.
  • Careful patient selection and monitoring can minimize side effects.
  • These therapies offer improved long-term outcomes by mitigating the adverse effects of chronic corticosteroid use.