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Pharmacy World and Science

, Volume 23, Issue 1, pp 17–21 | Cite as

Pharmacotherapeutical options in inflammatory bowel disease: an update

  • Y.H. Kho
  • M. Oudkerk Pool
  • F.G.A. Jansman
  • J.W. Harting
Article

Abstract

Chronic inflamatory bowel disease (IBD) refers to two diseases: Crohn's disease (CD) and ulcerative colitis (UC). The etiology of IBD remains unknown. The understanding of the pathogenesis has expanded greatly over the last decade. The combination of genetic risk factors, abnormalities in the immune system, vascular and neural factors, and random environmental factors may all play an important role.Most treatments currently in use have multiple action. The choice of appropriate medical treatment is determined by the status (inductive or maintenance therapy) and severity of the disease and the potential for toxicity. Despite the variety of medical therapies available for the treatment of IBD, none is ideal. Ongoing research into the well‐established drugs, as well as novel agents with more precise targets, may contribute to an optimal therapy of IBD in the near future. In this paper the current (5‐aminosalicylates, glucocorticosteroids, thioguanine derivatives, methotrexate, cyclosporin and infliximab) as well as some of the new (mycophenolate mofetil and thalidomide) therapeutic options are reviewed.

Crohn's disease Inflammatory bowel disease Medical treatment Ulcerative Colitis 

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References

  1. 1.
    Stenson WF. Inflammatory bowel disease. In:Yamada T, ed. Textbook of gastroenterology. Philadelphia: Lippincot Williams & Wilkins, 1999.Google Scholar
  2. 2.
    Ardizone S, Bollani S, Manzionna G, Bianchi Porro G. Inflammatory bowel disease approaching the 3rd millenium: pathogenesis and therapeutic implications? Eur J Gastroenterol Hepatol 1999;11:27-32.Google Scholar
  3. 3.
    Papadakis KA, Targan SR. Current theories on the causes of inflammatory bowel disease. Gastroenterol Clin North Am 1999;28:283-96.Google Scholar
  4. 4.
    Aabaken L, Osnes M. Non-steroidal anti-inflammatory druginduced disease in the distal ileum and large bowel. Scand J Gastroenterol 1989;24(suppl. 163):48-55.Google Scholar
  5. 5.
    Davies NM. Toxicity of nonsteroidal anti-inflammatory drugs in the large intestine. Dis Colon Rectum 1995;38:1311-21.Google Scholar
  6. 6.
    Gibson GR, Whitacre EB, Ricotti CA. Colitis induced by nonsteroidal anti-inflammatory drugs: report of four cases and review of the literature. Arch Intern Med 1992;152:625-32.Google Scholar
  7. 7.
    Bjorkman D. Nonsteroidal anti-inflammatory drug-associated toxicity of the liver, lower gastrointestinal tract, and esophagus. Am J Med 1998;105(5A):17-21S.Google Scholar
  8. 8.
    Alstead EM. The pill: safe sex and Crohn's disease. Gut 1999;45:165-6.Google Scholar
  9. 9.
    Godet PG, May GR, Sutherland LR. Meta-analysis of the role of oral contraceptive agents in inflammatory bowel disease. Gut 1995;37:668-73.Google Scholar
  10. 10.
    Timmer A, Sutherland LR, Martin F. The Canadian Mesalamine for remission of Crohn's disease study group. Oral contraceptive use and smoking are risk factors for relapse in crohn's disease. Gastroenterology 1998;114:1143-50.Google Scholar
  11. 11.
    Cosnes J, Carbonnel F, Carrat F, Beaugerie L, Gendre JP. Oral contraceptive use and the clinical course of Crohn's disease: prospective cohort study. Gut 1999;45:218-22.Google Scholar
  12. 12.
    Weterman IT, Pena AS. Familial incidence of Crohn's disease in the Netherlands and a review of the literature. Gastroenterology 1984;86:449Google Scholar
  13. 13.
    Carbonnel F, Macgaine G, Beaugerie L, Gendre JP, Cosnes J. Chron's disease severity in familial and sporadic cases. Gut 1999;44:91-5.Google Scholar
  14. 14.
    Andus T, Gross V. Etiology and pathofysiology of inflammatory bowel disease-environmental factors. Hepato-gastroenterol 2000;47:29-43.Google Scholar
  15. 15.
    Hultén K, Almashhrawi A, El-Zaatari FAK, Graham DY. Antibacterial therapy for Crohn's disease: a review emphasizing therapy directed against mycobacteria. Dig Dis Sci 2000;45:445-56.Google Scholar
  16. 16.
    Sonnenberg A. Geographic and temporal variations of sugar and margarine consumption in relation to Crohn's disease. Digestion 1988;41:517-22Google Scholar
  17. 17.
    Weinand I, Jordan A, Casparie WF, Stein J. Nutrition in the ethiogenesis of chronic inflammatory bowel diseases. Z Gastroenterol 1997;35:637-45.Google Scholar
  18. 18.
    Cosnes J, Carbonnel F, Carrat F, Beaugerie L, Cattan S, Gendre JP. Effects of current and former cigarette smoking on the clinical course of Crohn's disease. Aliment Pharmacol Ther 1999;13:1403-11.Google Scholar
  19. 19.
    Van Hogezand RA, Bemelman WA. Management of recurrent Crohn's disease. Neth J Med 1998;53:S32-8.Google Scholar
  20. 20.
    Thomas GA, Rhodes J, Ragunath K, Mani V, Williams GT, Newcombe RG, et al. Transdermal nicotine compared with oral prednisolone therapy for active ulcerative colitis. Eur J Gastroenterol Hepatol 1996;8:769-76.Google Scholar
  21. 21.
    Nilson A, Danielson A, Loftberg R, Benno P, Bergman L, Fausa O, et al. Olsalazine versus sulphasalazine for relapse prevention in ulcerative colitis: a multicenter study. Am J. Gastroenterol 1995;90:381-7.Google Scholar
  22. 22.
    Ghosh S, Shand A, Ferguson A. Ulcerative colitis. BMJ 2000;320:1119-23.Google Scholar
  23. 23.
    Rutgeerts P, Löfberg R, Malchow H et al. A comparison of budesonide with prednisolone for active Crohn's disease. N Engl J Med 1994;331:842-5.Google Scholar
  24. 24.
    Feagan BG, Rochon J, Fedorak RN, Irvine EJ, Wild G, Sutherland LR, et al. Methotrexate for the treatment of Crohn's disease. N Eng J Med 1995;332:292-7.Google Scholar
  25. 25.
    Lewis JD, Schwartz JS, Lichtenstein GR. Azathioprine for maintenance of remission in Crohn's disease: benefits outweigh the risk of lymphoma. Gastroenterology 2000;118:1018-24.Google Scholar
  26. 26.
    Present DH. Is mycophenolate mofetil a new alternative in the treatment of inflammatory bowel disease. Gut 1999;44:592-3.Google Scholar
  27. 27.
    Pearson D, May GR, Fick G, Sutherland LR. Azathioprine for maintaining remission of Crohn's disease. Cochrane Database Syst Rev 2000;(2):CD000067.Google Scholar
  28. 28.
    Bouhnik Y, Lémann M, Mary JY, Scemama G, Taï R, Matuchansky C, et al. Long-term follow-up of patients with Crohn's disease treated with azathioprine or 6-mercaptopurine. Lancet 1996;347:215-9.Google Scholar
  29. 29.
    Pearson DC, May GR, Fick GH, Sutherland LR. Azathioprine and 6-mercaptopurine in Crohn's disease. A meta-analysis. Ann Intern Med 1995;123:132-42.Google Scholar
  30. 30.
    Candy S, Wright J, Geber M, Adams G, Gerig M, Goodman R. A controlled double blind study of azathioprine in the management of Crohn's disease. Gut 1995;37:674-8.Google Scholar
  31. 31.
    D'haens G, Geboes K, Ponette E, Penninckx F, Rutgeerts P. Healing of severe recurrent ileitis with azathioprine therapy in patients with Crohn's disease. Gastroenterology 1997;112: 1475-81.Google Scholar
  32. 32.
    Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pasternack BS. Treatment of Crohn's disease with 6-mercaptopurine. A long term, randomized, double blind study. N Eng J Med 1980;302:981-7.Google Scholar
  33. 33.
    Feagan BG, Fedorak RN, Irvine EJ, Wild G, Sutherland LR, Steinhart AH, et al. A comparison of methotrexate with placebo for the maintenance of remission in Crohn's disease. N Eng J Med 2000;342:1627-32.Google Scholar
  34. 34.
    Brynskov J, Freund L, Rasmussen SN, Lauritsen K, de Muckadell OS, Williams N, et al. A placebo controlled, double blind, randomized trial of cyclosporine therapy in active chronic Crohn's disease. N Eng J Med 1989;321:845-50.Google Scholar
  35. 35.
    Lobo AJ, Juby LD, Rothwell J, Pool TW, Axon AT. Long term treatment of Crohn's disease with cyclosporine: the effect of a very low dose on maintenance of remission. J Clin Gastroenterol 1991;13:42-5.Google Scholar
  36. 36.
    Harting JW. New developments in the pharmacotherapy of inflammatory bowel disease. Pharm. Weekbl [Sci] 1992; 14(4A):275-86.Google Scholar
  37. 37.
    Targan SR, Hanauer SB, van Deventer SJH, Mayer L, Present DH, Braakman T, et al. A short-term study of chimeric monoclonalGoogle Scholar
  38. 38.
    Rutgeerts PJ, D'Haens G, Targan SR, Vasiliauskas EA, Hanauer SB, Present DH, et al. Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn's disease. Gastroenterology 1999;117: 761-9.Google Scholar
  39. 39.
    Bell SJ, Kamm MA. Antibodies to tumor necrosis factor αas treatment for Crohn's disease. Lancet 2000;355:858-60.Google Scholar
  40. 40.
    Neurath MF, Wanitschke, Peters M, Krummenauer F, Meyer zum Büschenfelde KH, Schlaak JF. Randomized trial of mycophenolate mofetil versus azathioprine for treatment of chronic active Crohn's disease. Gut 1999;44:625-8.Google Scholar
  41. 41.
    Vasiliauskas EA, Kam LY, Abreu-Martin MT, Hassard PV, Papadakis KA, Yang H, et al. An open label pilot study of low dose thalidomide in chronically active steroid dependent Crohn's disease. Gastroenterology 1999;117:1278-87.Google Scholar
  42. 42.
    Ehrenpreis ED, Kane SV, Cohen LB, Cohen RD, Hanauer SB. Thalidomide therapy for patients with refractory Crohn's disease: an open label trial. Gastroenterology 1999;117:1471-7.Google Scholar
  43. 43.
    Sands BE, Podolsky DK. New life in a sleeper: thalidomide and Crohn's disease. Gastroenterology 1999;117:1485-8.Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Y.H. Kho
    • 1
  • M. Oudkerk Pool
    • 1
  • F.G.A. Jansman
    • 1
  • J.W. Harting
    • 1
  1. 1.Department of Clinical PharmacyIsala kliniekenZwolleThe Netherlands

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