Advances in drug therapy for inflammatory bowel disease

Article Abstract:

Inflammatory bowel disease (IBD) is a general term for two specific conditions, Crohn disease and ulcerative colitis. Crohn disease, also known as regional ileitis, is a chronic inflammatory disease affecting the small intestine; symptoms include diarrhea, abdominal pain and weight loss. Colitis affects the colon, or large intestine, and is characterized by similar symptoms. Both conditions may follow a course of remissions and relapses over time. Drug therapy has been limited to sulfasalazine and corticosteroids until recently, when several new drug therapies for IBD were developed. In order to systematically evaluate the safety and effectiveness of the new therapies, an extensive computer search of the literature published between January 1980 and June 1989 was performed; 110 studies that were the most relevant to the topic were analyzed and others were reviewed as well. The author concluded that the aminosalicylates are proving to be a safe and effective treatment for IBD. The drug of choice for severe ulcerative colitis is corticotropin. Also available are new, effective forms of topical steroids that are metabolized faster than the standard forms and have less risk of side effects. For patients with either Crohn disease or colitis that has been difficult to control, immunosuppressive agents may be useful; these include 6-mercaptopurine and azathioprine. Cyclosporine may be helpful in patients who have not responded to any other drugs. Metronidazole may be beneficial for patients with Crohn colitis or refractory perineal Crohn disease. Many additional promising drugs will soon be tested for use in IBD; thus in the near future an even wider choice of drugs will be available to treat Crohn disease and ulcerative colitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

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New approaches may aid patients with inflammatory bowel disease

Article Abstract:

Inflammatory bowel disease (IBD) is a general term for two related intestinal illnesses, ulcerative colitis and Crohn's disease. The drug therapies currently available are of limited effectiveness and some cause serious side effects. Patients and researchers alike feel an urgent need for the development of new and better medications. It was recently confirmed that IBD is caused, in part, by a malfunction of the immune system; this has led to new optimism that effective treatments will be developed. The drugs currently being studied for use in treating IBD are reviewed. The oral medication mesalamine has achieved significant improvement of symptoms, and has led to remission in some patients with Crohn's disease and colitis. A group of drugs known as 5-aminosalicylic acids have been effective as enemas, but patient compliance was limited. Clinical trials are ongoing to test plaquenil, a drug normally used to treat malaria. Thus far, more than half of 45 patients given plaquenil, who were previously treated with steroids, no longer require steroids and are in remission. A partial response has been seen in other patients, and plaquenil appears to have minimal side effects. A drug that affects the immune system, methotrexate, has resulted in an 83 percent response rate among Crohn's disease patients and a 70 percent response rate among colitis patients; some were able to discontinue taking steroids. Also being investigated are cyclosporine and fish oil, but it should be noted that the latter did not improve bleeding, cramps, and frequency of bowel movements. None of these drugs have yet been proved to be completely safe and effective, but it is hoped that some will be safer for long-term use than steroids. (Consumer Summary produced by Reliance Medical Information, Inc.)

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6-mercaptopurine in the management of inflammatory bowel disease: short- and long-term toxicity

Article Abstract:

The toxicity of 6-mercaptopurine, which is used to treat inflammatory bowel disease, was evaluated in 396 patients over 18 years. One hundred and twenty patients had ulcerative colitis, or inflammation of the colon associated with ulcers, and 276 had Crohn disease, inflammation of the ileum, a portion of the small intestine. Ninety percent of the patients were followed-up over a period of 60 months. 6-mercaptopurine caused pancreatitis, or inflammation of the pancreas in 13 patients, bone marrow depression in eight patients, allergic reactions in eight patients, and hepatitis, or inflammation of the liver, in one patient. These toxic effects were reversible and did not result in death. Bone marrow depression occurred early in the study and was associated with the higher doses of 6-mercaptopurine. Out of 29 cases of infections, seven were severe, including one case of herpes zoster encephalitis, or inflammation of the brain due to infection with the herpes zoster virus. The infections were reversible or curable and did not lead to death. Out of 12 neoplasms, abnormal growths, there was only one case, a diffuse histiocytic lymphoma of the brain, that could be related to 6-mercaptopurine use. The results show that 6-mercaptopurine is relatively safe and effective in treating inflammatory bowel disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Mercaptopurine

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