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Medical therapies for ulcerative colitis and crohn’s disease

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Abstract

This review focuses on data reported in the last year on medical treatment of Crohn’s disease and ulcerative colitis. In Crohn's disease, a broad range of cytokine-based therapies are currently being tested. Although all are very exciting, the anti-tumor-necrosis-factor (TNF) approach remains the most effective, with infliximab (a chimeric monoclonal antibody directed against TNF) being the most active agent. With repeated infusions every 8 weeks, remission is induced and can be maintained even in refractory patients with no major apparent side effects. Thalidomide, an oral agent with anti-TNF effects, shows promise in noncontrolled experience. Important new data on azathioprine/ 6-mercaptopurine (6-MP) and its metabolites are also helpful. Methotrexate can induce remissions in 6-MP-allergic or refractory Crohn's patients and has now shown efficacy as a maintenance agent. Beneficial effects are also reported for a variety of new agents: mycophenolate mofetil, tacrolimus (FK506), growth hormone, and granulocyte colony-stimulating factor (G-CSF). Important observations in ulcerative colitis (UC) over the past year include evidence of a protective effect of 5-aminosalicylic acid (5-ASA) with respect to colorectal cancer, negative results from a study for heparin monotherapy, and results from a comparison of mycophenolate mofetil versus azathioprine as maintenance therapy. Epidemiologically, the negative association between appendectomy and UC was corroborated in a meta-analysis, suggesting an immunologic role for this organ. Finally, in chronic pouchitis, probiotic therapy was found to maintain remissions very significantly.

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  1. Departments of Gastroenterology and Internal Medicine, University Hospital Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium

    Filip J. Baert MD & Paul J. Rutgeerts MD

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  1. Filip J. Baert MD
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  2. Paul J. Rutgeerts MD
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Baert, F.J., Rutgeerts, P.J. Medical therapies for ulcerative colitis and crohn’s disease. Curr Gastroenterol Rep 2, 446–450 (2000). https://doi.org/10.1007/s11894-000-0006-z

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  • DOI: https://doi.org/10.1007/s11894-000-0006-z

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