Optimizing drug therapy in inflammatory bowel disease.
This article reviews current data to optimize the use of both older and newer drugs in inflammatory bowel disease. For patients with severe ulcerative colitis (UC), steroid dosing has been clarified, and a mega-analysis of steroid outcomes and toxicities has been reported. In regard to mesalamine, recent information has suggested benefit of a higher dose of pH-dependent release mesalamine for patients with moderate UC. Also, a once-daily formulation with Multi-Matrix System (MMX) technology (Shire Pharmaceuticals, Wayne, PA), has been approved. In regard to cyclosporine, two centers have reported an increased rate of colectomy over a long-duration follow-up of a cyclosporin A course given for UC. Additional information regarding thiopurines has been published, including the use of metabolite testing and duration of therapy for these drugs. Lastly, additional information regarding the optimal method for using anti-tumor necrosis factor therapy continues to accumulate.
Swaminath
Arun
A
Henry D. Janowitz Division of Gastroenterology, Mount Sinai School of Medicine, 1425 Madison Avenue, Box 1069, New York, NY 10029, USA. Arun.Swaminath@mssm.edu
Kornbluth
Asher
A
D015502:Absorptiometry, Photon; D000068879:Adalimumab; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D001379:Azathioprine / Q000008:administration & dosage / Q000378:metabolism; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy; D016572:Cyclosporine / Q000008:administration & dosage; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab; D015122:Mercaptopurine / Q000031:analogs & derivatives / Q000378:metabolism; D019804:Mesalamine / Q000008:administration & dosage; D010349:Patient Compliance; D011241:Prednisone / Q000008:administration & dosage; D017211:Treatment Failure
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D019804:Mesalamine; C010240:6-methylthiopurine; D016572:Cyclosporine; D000069285:Infliximab; D015122:Mercaptopurine; D000068879:Adalimumab; D001379:Azathioprine; D011241:Prednisone