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Optimizing therapy for inflammatory bowel disease

M Robinson1

  • 1Oklahoma Foundation for Digestive Research, Oklahoma City 73104, USA.

The American Journal of Gastroenterology
|December 12, 1997
PubMed
Summary
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This review examines current inflammatory bowel disease (IBD) therapies, including corticosteroids, aminosalicylates, and immunomodulators. While new agents show promise, ongoing research aims for optimal IBD treatment regimens.

Area of Science:

  • Gastroenterology
  • Pharmacology
  • Immunology

Background:

  • Conventional corticosteroids are mainstays for acute inflammatory bowel disease (IBD) but have significant side effects with chronic use.
  • Budesonide offers a safer alternative for inducing remission in certain IBD types.
  • Aminosalicylates are effective for mild-to-moderate IBD and remission maintenance, with higher mesalamine doses and combination therapies showing increased efficacy.

Purpose of the Study:

  • To review current developments in major therapeutic categories for inflammatory bowel disease (IBD) management.
  • To evaluate the efficacy and safety of established and novel IBD therapies.
  • To highlight areas for future research in optimizing IBD treatment.

Main Methods:

  • Review of current literature on IBD therapeutic agents.

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  • Analysis of data from clinical trials on corticosteroids, aminosalicylates, immunomodulators, biologics, and antibiotics.
  • Assessment of investigational agents for IBD treatment.

    • Main Results:

    • Budesonide shows promise for active distal ulcerative colitis (UC) and Crohn's disease.
    • Aminosalicylates are effective for mild-to-moderate UC and Crohn's disease, with dose and formulation strategies impacting outcomes.
    • Immunomodulators (azathioprine, 6-mercaptopurine, methotrexate) are accepted IBD treatments; cyclosporine requires careful monitoring.
    • Biologics (IL-10, IL-11, anti-TNFalpha) and antibiotics (metronidazole) show potential, warranting further trials.
    • Investigational agents like acemannan, heparin, and nicotine present variable promise.

    Conclusions:

    • No single IBD therapy is ideal; a combination of established and novel agents is often necessary.
    • Ongoing research into targeted therapies may lead to more optimal IBD treatment regimens.
    • Further clinical trials are needed to confirm the efficacy of antibiotic and other investigational therapies for IBD.