Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease (IBD) or for patients resistant to steroids. These drugs help maintain remission, prevent recurrence post-surgery, and treat fistulas in Crohn's disease. Adverse effects include pancreatitis, fever, rash, arthralgias, nausea, vomiting, bone marrow suppression, and liver function test elevations.
Methotrexate (Trexall), another immunomodulatory agent, inhibits dihydrofolate reductase, blocking DNA synthesis and inducing cell death. It also inhibits purine metabolism, T-cell activation, cytokine production, and other vital processes, providing anti-inflammatory effects. It is reserved for steroid-resistant or steroid-dependent IBD patients and is used to maintain remission while reducing the formation of anti-drug antibodies. It is administered parenterally with a dose of 15-25 mg/week for induction and maintenance of remission in Crohn's disease. Various adverse effects are nausea, loose stool, stomatitis, cutaneous eruption, CNS symptoms, alopecia, fever, and hematologic abnormalities.
Crohn's disease is an inflammatory bowel disorder characterized by discontinuous chronic inflammation of the GI tract.
Treatment strategies encompass immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy.
Based on the extent and severity of the inflammation, immunomodulators, such as azathioprine, 6-mercaptopurine, and methotrexate can be administered with glucocorticoids or anti-TNF agents.
Azathioprine is metabolized into 6-mercaptopurine that subsequently forms active 6-thioguanine nucleotides, which inhibits purine synthesis and cell proliferation.
These drugs help maintain remission, prevent post-surgery recurrence, and treat fistulas in Crohn's disease.
Their adverse effects include nausea, vomiting, pancreatitis, fever, rash, and decreased blood cell counts via bone marrow suppression.
Methotrexate inhibits dihydrofolate reductase, suppressing immune cell proliferation and inducing cell death. It also inhibits purine metabolism, T-cell activation, and cytokine production, providing anti-inflammatory effects.
Side effects may include headache, vomiting, abdominal discomfort, rash, and RBC enlargement or macrocytosis.
繁體中文
