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State-of-the-Art Medical Therapy of the Adult Patient with IBD: The Immunomodulators

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Inflammatory Bowel Disease

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

AZA/6-MP are the most well-studied immunomodulators effective at reducing steroid use, inducing and maintaining remission in CD and UC. TPMT phenotype (genotype if phenotype not available) should be checked in all patients before initiating therapy with AZA or 6-MP, to avoid profound bone marrow toxicity and to facilitate more complete dosing earlier. Methotrexate is an effective alternative to AZA/6-MP in Crohn’s disease and possibly in UC if given parenterally at doses >15 mg/week. Cycosporine A is effective at inducing remission in severe UC, and may lead to a reduced rate of colectomy if used as a bridge to long-term AZA or 6-MP therapy. Tacrolimus, mycophenolate mofetil, and thalidomide may have a role as third line immunomodulators in complicated or fistulizing CD. 6-Thioguanine should not be used as a therapy for active IBD due to frequent hepatotoxicity and occurrence of nodular regenerative hyperplasia.

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  1. Section of Gastroenterology, University of Manitoba IBD Clinical and Research Centre, 804F-715 McDermot Avenue, Winnipeg, Manitoba, Canada, R3E3P4

    Charles N. Bernstein

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  1. MC 4076, Sect. Of GE, Hepatol. & Nutr., Department of Medicine, University of Chicago Medical Center, S. Maryland Ave. 5841, Chicago, 60637, Illinois, USA

    Russell D. Cohen

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Moffatt, D., Bernstein, C.N. (2011). State-of-the-Art Medical Therapy of the Adult Patient with IBD: The Immunomodulators. In: Cohen, R. (eds) Inflammatory Bowel Disease. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-433-3_7

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