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Drugs for Treatment of Ulcerative Colitis in IBD01:29

Drugs for Treatment of Ulcerative Colitis in IBD

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Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
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Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

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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...
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Inflammatory Bowel Disease I: Ulcerative Colitis01:27

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Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
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Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids01:21

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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...
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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...
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Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents01:24

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In the intricate landscape of the gastric lumen, excessive acid secretion disrupts the natural defense mechanisms, weakening the mucus-bicarbonate barrier. This vulnerability allows pepsin to infiltrate epithelial cells, digesting mucosal proteins and triggering erosion, leading to ulcer formation.
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Two cases of ulcerative colitis that developed while using abatacept.

Takeshi Takasago1, Ryohei Hayashi2, Yoshitaka Ueno3

  • 1Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.

Clinical Journal of Gastroenterology
|July 14, 2022
PubMed
Summary

Abatacept (CTLA-4Ig) therapy for rheumatoid arthritis can lead to ulcerative colitis. Early recognition of gastrointestinal symptoms and prompt treatment are crucial for patient recovery.

Keywords:
AbataceptCytotoxic T lymphocyte-associated antigen-4 IgDrug-induced colitisUlcerative colitis

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Area of Science:

  • Immunology
  • Gastroenterology
  • Pharmacology

Background:

  • Abatacept (ABT), a CTLA-4Ig fusion protein, modulates T-cell activation and is used for rheumatoid arthritis (RA) and juvenile idiopathic arthritis.
  • Its mechanism involves inhibiting CD80/CD86 and CD28 co-stimulation, crucial for T-cell immune responses.

Observation:

  • Two male RA patients developed ulcerative colitis (UC) during Abatacept treatment.
  • Symptoms included diarrhea and hematochezia, appearing 2 and 15 months after initiating ABT therapy.
  • No prior gastrointestinal issues were reported before ABT initiation.

Findings:

  • Colonoscopies confirmed ulcerative colitis findings in both patients.
  • Discontinuation of Abatacept and subsequent UC treatment led to clinical improvement.
  • These cases align with previously reported instances of UC development during ABT therapy.

Implications:

  • Ulcerative colitis should be considered in RA patients on CTLA-4Ig agents presenting with diarrhea and hematochezia.
  • Awareness of this potential adverse effect is critical for timely diagnosis and management.
  • Further research may elucidate the precise mechanisms linking CTLA-4Ig therapy to inflammatory bowel disease development.