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J Korean Med Assoc > Volume 49(12); 2006 > Article
Park and Kim: Medical Treatment of Inflammatory Bowel Disease

Abstract

Ulcerative colitis (UC) and Crohn's disease (CD), the primary constituents of inflammatory bowel disease (IBD), are precipitated by a complex interaction of environmental, genetic, and immunoregulatory factors. A growing body of data implicates a dysfunctional mucosal immune response to commensal bacteria in the pathogenesis of IBD, especially CD. Medical management of IBD includes two treatment strategies: induction and maintenance of remission. 5-Aminosalycilates are mostly used for mild active IBD and for maintenance treatment of UC. Glucocorticoids remain, despite their frequent (and occasionally severe) side effects, as the mainstay for induction of remission in moderate to severe active IBD, both UC and CD. However, these agents, although beneficial for many patients with IBD, are not effective for the majority of patients over the long term. Immunomodulators including azathioprine(AZA), 6-mercaptopurine(6-MP), or methotrexate are effective in the treatment of CD or UC. Cyclosporine and infliximab have emerged as the main, rapid-acting, alternatives in steroid-refractory UC and CD, respectively. In addition, infliximb was approved recently in the treatment of UC. The large number of new agents presents a bewildering challenge to practitioners anticipating their use in the clinic. Unfortunately, in spite of recent remarkable advances in medical therapy of IBD, there have been no any curative therapeutic agents for IBD up to now. Therefore, the treatment is should be individualized according to the severity of the disease and clinical course of the patients with IBD. And, it is also very important to prescribe the therapeutic agents correctly and appropriately for the patients with IBD.

References

1. Jay M. Retrograde spreading of hydrocortisone enema in inflammatory bowel disease. Dig Dis Sci 1986;31:139-144.

2. Champman NJ. Distribution of mesalmaine enemas in patients with active distal ulcerative colitis. Mayo Clin Proc 1992;67:245-248.

3. Williams CN, Haber G, Aquino JA. Double-blind, placebo-controlled evaluation of 5-ASA suppositories in active distal proctitis and measurement of extent of spreading using TC-labeled 5-ASA suppositories. Dig Dis Sci 1987;32:71S-75S.

4. Campieri M, De Franchis R, Bianchi Porro G, Ranzi T, Brunetti G, Barbara L. Mesalazine (5-ASA) suppositories in the treatment of ulcerative proctitis or distal proctosigmoiditis. A randomized controlled trial. Scand J Gastroenterol 1990;25:663-668.

5. D'Arienzo A, Panares A, D'Armiento FP, Lancia C, Quattrone P, Giannattasio F, et al. 5-Aminosalicylic acid suppositories in the maintenance of remission in idiopathic proctitis or proctosigmoiditis: a double-blind placebo-controlled clinical trial. Am J Gastroenterol 1990;85:1079-1082.

6. Sutherland LR, Martin F, Greer S, Robinson M, Greenberger N, Saibil F, et al. 5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis. Gastroenterology 1987;92:1894-1898.

7. Surtherland LR, Martin F. 5-Aminosalicylic acid enenmas in the maintenance of remission in distal ulcerative colitis and proctitis. Am J Gastroenterol 1987;1:3-6.

8. Campieri M, Lanfranchi GA, Bazzochi G, Brignola C, Sarti F, Franzin G, et al. Treatment of ulcerative colitis with high-dose 5-aminosalicylic acid enemas. Lancet 1981;2:270-273.

9. Danish 5-ASA study group. Topical 5-ASA vs. prednisolone in ulcerative proctosigmoiditis. Dig Dis Sci 1982;32:598-604.

10. Marshall JK, Irvine EJ. Rectal corticosteroids versus alternative treatments in ulcerative colitis: A meta analysis. Gut 1997;40:775-780.

11. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic therapy for mildly to moderately ulcerative colitis. A randomised trial. N Engl J Med 1987;317:1625-1629.

12. Rosenberg JL, Wall AJ, Levin B, Binder HJ, Kirsner JB. A controlled trial of azathioprine in the management of chronic ulcerative colitis. Gastroenterology 1975;69:96-99.

13. Adler DJ, Korelitz BI. The therapeutic efficacy of 6-mercaptopurine in refractory ulcerative colitis. Am J Gastroenterol 1990;85:717-722.

14. Fraser AG, Jewell DP. Side effects of azathioprine given for inflammatory bowel disease-A 30 year audit. Gastroenterology 2000;118:A787.

15. Conelll WR, Kamm MA, Dickson M, Balkwill AM, Ritchie JK, Lennard-Jones JE. Long-term neoplasia risk azathioprine treatment in inflammatory bowel disease. Lancet 1994;343:1249-1252.

16. Oren R, Arber N, Odes S, Moshkowitz M, Keter D, Pomeranz I, et al. Methotrexate in chronic active ulcerative colitis: a double-blind, randomized, Israeli multicenter trial. Gastroenterology 1996;110:1416-1421.

17. Eaden J. The data supporting a role for aminosalicylates in the chemoprevention of colorectal cancer in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2003;18:S2. 15-21.

18. Velayos FS, Terdiman JP, Walsh JM. Effect of 5-aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and meta-analysis of observation studies. Am J Gastroenterol 2005;100:1345-1353.

19. Meyers S, Sachar DB, Goldberg JD, Janowitz HD. Corticotropin versus hydrocortisone in the intravenous treatment of ulcerative colitis. A prospective, randomized, double-blind clinical trial. Gastroenterology 1983;85:351-357.

20. Kaplan HP, Portnoy B, Binder HJ, Amatruda T, Spiro H. A controlled evaluation of intravenous adrenocorticotropic hormone and hydrocortisone in the treatment of acute colitis. Gastroenterology 1975;69:91-95.

21. Powell-Tuck J, Bucknell NA, Lennard-Jones JE. A conrolled comparison of corticotropin and hydrocortisone in the treatment of severe proctocolitis. Scand J Gastroenterol 1977;12:971-975.

22. Lichtiger S, Present DH, Kornbluth A, Gelernt I, Bauer J, Galler G, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994;330:1841-1845.

23. Van Assche G, D'Haens G, Noman M, Vermeire S, Hiele M, Asnong K, et al. Randomized, double-blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis. Gastroenterology 2003;125:1025-1031.

24. Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 2005;353:2462-2476.

25. Hanauer SB, Stromberg U. Oral Pentasa in the treatment of active Crohns disease: a meta-analysis of double-blind, placebo-controlled trials. Clin Gastroenterol Hepatol 2004;2:379-388.

26. Markowitz J, Grancher K, Kohn N, Lesser M, Daum F. A multicenter trial of 6-mercaptopurine and prednosone in children with newly diagnosed Crohn's disease. Gastroenterology 2000;119:895-902.

27. Sandborn W, Sutherland L, Pearson D, May G, Modigliani R, Prantera C. Azathioprine or 6-mercaptopurine for inducing remissions of Crohn's disease. Cochrane Database Syst Rev 2000;2:CD000545.

28. Feagan BG, Rochon J, Fedorak RN, Irvine EJ, Wild G, Sutherland L, et al. The North American Crohn's Study Group of Investigators. Methotrexate for the treatment of Crohn's disease. N Engl J Med 1995;332:292-297.

29. Feagan BG, Fedorak RN, Irvine EJ, Wild G, Sutherland L, Steinhart AH, et al. North American Crohn's Study Group of Investigators. A comparison of methotrexate with placebo for the maintenance of remission in Crohn's disease. N Engl J Med 2000;342:1627-1632.

30. Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, Braakman T, et al. Crohn's Disease cA2 Study Group. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn's disease. N Engl J Med 1997;337:1029-1035.

31. Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer LL, van Hozegand RA, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999;340:1398-1405.

32. Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, et al. Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial. Lancet 2002;359:1541-1549.

33. Sands BE, Anderson FH, Bernstein CN, Che WY, Fegan BG, Fedorak RN, et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med 2004;350:876-885.

34. Sands BE, Blank MA, Patel K, van Deventer SJ. Long-term treatment of rectovaginal fistula in Crohn's disease: response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol 2004;2:912-920.

35. Sandborn WJ, Present DH, Isaacs KL, Wolf DC, Greenberg E, Hanauer SB, et al. Tacrolimus for the treatment of fistulas in patients with Crohn's disease: a randomised, placebo-controlled trial. Gastroenterology 2003;125:380-388.

Figure 1
Infliximab treatment algorithm for Crohn's disease
jkma-49-1164-g001-l.jpg
Table 1
Main factors influencing therapeutic decisions in active IBD
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Table 2
Oral 5-aminosalicylate formulations
jkma-49-1164-i002-l.jpg
Table 3
Biological compounds in development for inflammatory bowel disease
jkma-49-1164-i003-l.jpg

PCT : Placebo-controlled trial



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