IBD Treatments

Question 1

What are the three general treatment options (classe) for IBD?

Answer 1

1. anti-infalmmatory agents (ASAs)
2. immunosuppressive agents (corticosteroids and antimetaoblites)
3. anti-TNAalpha therapy

Question 2

What are the 4 aminosalicylates used for IBD?

Answer 2

Balsalazide
Mesalamine
Olsalazine
Sulfasalazine

(MOBS)

Question 3

Why are these all 5-ASAs?

Answer 3

the 5 - means they have an adidtional grou on the ASA that inhibits it’s absorption in the stomach

when it reaches the intestine it will be removed by gut bacteria, releasing the ASA

Question 4

How does the ASA work?

Answer 4

How it always works…

inhibits COX to lower prostaglanding synthesis

Question 5

Of the 5-ASAs, which one works only in the large intestine?

Answer 5

Balsalazide

Question 6

How can you get 5-ASA action only in the rectum?

Answer 6

use a suppository

Question 7

What is the therapeutic use for the 5-ASAs

Answer 7

mild to moderate UC

Question 8

Why aren’t the 5 ASAs typically useful in CD?

Answer 8

CD is typically more severe at presentation, so you can’t get a high enough dose to get it to work

Question 9

Side effects are usually minimal for the 5-ASAs because they’re not systemically absorbed. what’s the exception?

Answer 9

SULFAsalazine

the sulfa part can trigger hypersensitiviey and decreased folate absorption

40% will have GI upset, headache, arthralgias and bone marrow suppression

Question 10

What three corticosteroids are used for IBD?

Answer 10

budesonide
prednisone
prednisolone

Question 11

What’s special about budesonide?

Answer 11

it’s subject to rapid first pas metabolism, giving it poor oral abioavailability

this means it has a local rather than systemic effect compared to other oral steroids! Only works in GI tract and lung

thus less side effects

Question 12

How will UC vs CD shape which corticosteroid you use?

Answer 12

prednisone and prednisolone are used in moderate to severe active IBD

Budesonide is used in mild to moderate CD involving the ileum and proximal colon

Question 13

What are the three antimetabolite immunosuprpessors used for IBD?

Answer 13

azathioprine
6-mercaptopurine
Methotrexate

Question 14

What’s the antiTNFalpha drug we use?

Answer 14

infliximab (and adalimumab)

Question 15

Why does influximab work in particular with IBD?

Answer 15

IBD invovles dysregulation of the Th1 response, which causes increased TNFalpha

so blockign it helps

Question 16

Why do 1/3 become refractoryon infliximab?

Answer 16

infliximab is a chimetric mouse protein so you can develop anitbodies against it

Question 17

Infliximab can lead to symptomatic improvement in what percent? Remision in what percent?

Answer 17

60% have symptomatic improvement

30% have remission

Question 18

What are the side effects of infliximab?

Answer 18

1. infection - more common with infliximab than with other antibodies
2. reactivation of TB - TEST FIRST!
3. Influsion rections
4. sme severe hepatic problems
5. increased risk of lymphoma (unique to Infliximab - but IBD has incfeased risk anyways)

Question 19

Describe the pyramid steps for treatment of IBD based on increased severity (and unfortunately increased refractiveness).

Answer 19

1. 5 ASA
2. antiboitocis
3. topical corticosteroid - budesonide
4. azathrioprin, 6=MP, MTX
5. oral corticosteroids (prednisone, prednisolone)
6. infliximab
   7/ IV corticosteroids
7. cyclosporine
8. surgery