Clinical pharmacology of inflammatory bowel disease therapies.
Knowledge about the clinical pharmacology of medical therapy of inflammatory bowel disease has incrementally advanced. Small studies with mesalamine have suggested that intestinal mucosal concentrations of mesalamine may predict clinical response to mesalamine therapy. Increased expression of glucocorticoid receptor beta and increased expression of the multidrug resistance drug pump P-glycoprotein 170 have been proposed as markers of drug resistance to glucocorticoids. A baseline determination of thiopurine methyltransferase phenotype or genotype may predict early leukopenia in patients treated with azathioprine or 6- mercaptopurine. Serial measurement of erythrocyte 6-thioguanine nucleotides may be useful in tailoring the dose of these medications. A loading dose of intravenous azathioprine does not accelerate the time to response in patients with steroid-treated Crohn's disease; however, standard azathioprine may work more quickly than previously reported. Methotrexate, 15 to 25 mg/wk, is effective for the treatment of Crohn's disease (active or in remission), and there is no significant difference in the erythrocyte concentrations of methotrexate polyglutamate in patients with inflammatory bowel disease receiving 15 mg, compared with 25 mg, subcutaneously on a weekly basis.
Sandborn
W J
WJ
Inflammatory Bowel Disease Clinic, Division of Gastroenterology, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA. sandborn.william@mayo.edu
Faubion
W A
WA
D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000378:metabolism / Q000627:therapeutic use; D001379:Azathioprine / Q000378:metabolism; D015415:Biomarkers; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000378:metabolism; D003424:Crohn Disease / Q000188:drug therapy / Q000378:metabolism; D004351:Drug Resistance; D006801:Humans; D007166:Immunosuppressive Agents / Q000378:metabolism / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000378:metabolism*; D007413:Intestinal Mucosa / Q000737:chemistry; D019804:Mesalamine / Q000378:metabolism / Q000627:therapeutic use; D008727:Methotrexate / Q000378:metabolism / Q000627:therapeutic use; D010597:Pharmacogenetics; D011965:Receptors, Glucocorticoid / Q000378:metabolism
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D007166:Immunosuppressive Agents; D011965:Receptors, Glucocorticoid; D019804:Mesalamine; D001379:Azathioprine; D008727:Methotrexate