Medical therapies for ulcerative colitis and Crohn's disease.
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 non-controlled 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.
Baert
F J
FJ
Department of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium.
Rutgeerts
P J
PJ
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D000963:Antimetabolites / Q000378:metabolism / Q000627:therapeutic use; D001062:Appendectomy; D001379:Azathioprine / Q000378:metabolism / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015122:Mercaptopurine / Q000378:metabolism / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D012074:Remission Induction
D000276:Adjuvants, Immunologic; D000636:Aminosalicylic Acids; D000963:Antimetabolites; D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D009173:Mycophenolic Acid; D001379:Azathioprine