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Refractory IBD: medical management

W J Tremaine1

  • 1Inflammatory Bowel Disease Clinic, Mayo Clinic, Rochester MN 55905, USA.

The Netherlands Journal of Medicine
|February 1, 1997
PubMed
Summary
This summary is machine-generated.

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Issues in the development of practice guidelines for inflammatory bowel disease.

Inflammatory bowel diseases·2013

Refractory inflammatory bowel disease (IBD) treatments like azathioprine and methotrexate offer options for Crohn's disease and ulcerative colitis. While effective, these therapies have potential side effects requiring careful patient monitoring.

Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Refractory inflammatory bowel disease (IBD) presents a significant clinical challenge, characterized by persistent symptoms despite standard anti-inflammatory treatments.
  • Management of refractory IBD necessitates exploring alternative therapeutic strategies beyond conventional therapies.

Purpose of the Study:

  • To review current and emerging treatment options for refractory inflammatory bowel disease (IBD).
  • To evaluate the efficacy and safety profiles of various immunomodulators and experimental therapies in IBD management.

Main Methods:

  • Literature review of established and investigational treatments for IBD.
  • Analysis of clinical trial data and observational studies on azathioprine (AZA), 6-mercaptopurine (6-MP), methotrexate (MTX), and cyclosporine (CYA).

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  • Examination of emerging cytokine-based therapies, including antagonists and anti-inflammatory cytokines.

    • Main Results:

    • 6-mercaptopurine (6-MP) demonstrates efficacy in approximately 75% of Crohn's disease patients, with a mean onset of action of 3.1 months.
    • Azathioprine (AZA) serves as a steroid-sparing agent in ulcerative colitis, with side effects in 10-15% of patients.
    • Methotrexate (MTX) achieves remission in about 40% of Crohn's disease patients but carries a risk of hepatic fibrosis. Cyclosporine (CYA) shows acute efficacy in severe ulcerative colitis but is less effective for long-term Crohn's disease management, with risks of hypertension and renal insufficiency.
    • Experimental therapies like anti-tumor-necrosis-factor-alpha antibodies and interleukin 10 show promise for Crohn's disease.

    Conclusions:

    • Established immunomodulators like AZA, 6-MP, and MTX provide valuable treatment options for refractory IBD, each with distinct efficacy rates and side effect profiles.
    • Cyclosporine (CYA) has a role in acute severe ulcerative colitis, but long-term use in Crohn's disease is limited.
    • Emerging biologic therapies targeting specific cytokines represent a promising frontier for managing refractory IBD, offering potential for improved targeted treatment.