Advanced Therapy for Inflammatory Bowel Disease: A Guide for the Primary Care Physician

Abstract

Primary care physicians care for patients with inflammatory bowel disease (IBD) who are receiving advanced therapies that include immunomodulator drugs (eg, azathioprine and methotrexate) and biologic therapy. These agents have significantly improved remission rates and the quality of life for patients suffering from IBD. However, patients taking these drugs need special care and counseling with regard to adverse effects, infection risk, cancer risk, and pregnancy. Newer treatment paradigms incorporate earlier use of biologic therapy, often in combination with immunomodulator drugs, to alter the natural course of the disease. Comprehensive care for these patients, including health maintenance, requires collaboration between primary care physicians and gastroenterologists. Despite their high cost, advanced therapies are likely to be cost-effective. This article discusses general concepts about azathioprine, 6-mercaptopurine, methotrexate, and common biologic drugs used in IBD. ( J Am Board Fam Med 2014;27:411-420.)

Inflammatory bowel disease pathobiology: the role of the interferon signature

“…Recent data, however, suggest that the early initiation of more aggressive treatment, such as biologic therapy, can modify disease progression and may lead to less damage. Immunomodulatory drugs are often used in combination with biologics in IBD patients with severe disease for the maintenance of remission [5]. Apart from these well-studied treatments, systemic administration of type I interferon ([IFN], e.g., IFN-α, IFN-β) in IBD patients has been evaluated for the suppression of disease burden, with controversial results.…”

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“…Although the etiology of IBD has not yet been well defined, aspects such as genetics, intestinal microbiome and the immunomodulatory responses influenced by the environment are the target of the new therapies [8]. The therapies currently approved for the treatment of UC or CD, whose goal is to reduce the inflammatory status, include aminosalicylates, corticosteroids, immunomodulators and biological drugs [9,10]. The latter may be divided into two main categories: anti-tumor necrosis factor (anti-TNF) drugs (eg.…”

Stem cell-based therapies in inflammatory bowel disease: promises and pitfalls

“…Subsequently followed by corticosteroids, immunomodulators, and biologics. When all else fails, the final option tends to be surgery [Thomas and Lodhia, 2014].…”