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Related Concept Videos

Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

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...
Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase01:11

Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase

Genetic polymorphisms in drug targets have emerged as critical determinants of interindividual variability in drug response and toxicity. Pharmacogenomic investigations increasingly focus on identifying these variations to personalize and optimize therapeutic interventions. A drug target may be a receptor, enzyme, or signaling protein involved in pharmacologic responses or disease-related pathways. While early pharmacogenetic studies focused primarily on drug metabolism, current research...
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids01:21

Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids

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),...
Therapeutic Drug Monitoring: Overview and Classification01:16

Therapeutic Drug Monitoring: Overview and Classification

Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood at designated intervals to ensure the drug concentration stays within a therapeutic range. This monitoring is crucial for optimizing individual dosage regimens, enhancing therapeutic efficacy, and minimizing drug-related toxicity. TDM is vital for drugs with narrow therapeutic windows, significant variability in pharmacokinetics, and a clear correlation between plasma levels and...
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF01:24

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF

Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab (Humira),...

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Methotrexate: should we start using it in clinical practice?

Pal Miheller1, Lajos S Kiss, Michael Mandel

  • 11st Department of Medicine, Semmelweis University, H-1083 Budapest, Korányi S. 2A, Hungary. lakatos.peter_laszlo@med.semmelweis-univ.hu.

Current Drug Targets
|May 9, 2013
PubMed
Summary

Methotrexate (MTX) is increasingly used for inflammatory bowel diseases (IBD), showing efficacy in Crohn's disease but needing more data for ulcerative colitis. Its role in combination therapy requires further investigation due to mixed results and side effect concerns.

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Therapeutic strategies for inflammatory bowel disease (IBD) have evolved, with early immunosuppression being key for high-risk patients.
  • Azathioprine is common, but patient intolerance/refractoriness necessitates alternative immunosuppressants.
  • Methotrexate (MTX), established in other inflammatory conditions, is gaining traction in IBD management.

Purpose of the Study:

  • To review the current efficacy and side effect profile of methotrexate (MTX) in inflammatory bowel disease (IBD).
  • To re-evaluate the place of MTX within the current therapeutic landscape for IBD.
  • To explore potential new indications for MTX, including combination therapy with biologics.

Main Methods:

  • Review of landmark trials and subsequent studies on methotrexate use in Crohn's disease and ulcerative colitis.
  • Analysis of data regarding MTX combination therapy with biologicals in IBD.
  • Evaluation of reported side effects and long-term safety concerns associated with MTX.

Main Results:

  • Evidence supports MTX use for induction and maintenance of remission in Crohn's disease.
  • Evidence for MTX in ulcerative colitis is less robust, with ongoing trials.
  • Combination therapy with biologics shows potential for preventing anti-drug antibodies but lacks consistent efficacy data.

Conclusions:

  • Methotrexate is a significant immunomodulator in IBD, particularly Crohn's disease.
  • Further research is needed to solidify MTX's role in ulcerative colitis and combination therapies.
  • Balancing efficacy against side effects and safety concerns is crucial for optimizing MTX use in IBD.