Inflammatory Bowel Disease: Current Therapeutic Options

Abstract

Medical management of inflammatory bowel diseases (IBD) includes two treatment strategies: induction and maintenance of remission. 5-Aminosalycilates are mostly used for mild active IBD and for maintenance treatment in ulcerative colitis (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 Crohn’s disease (CD). Cyclosporine and infliximab have emerged as the main, rapid-acting, alternatives in steroid-refractory UC and CD, respectively. Thiopurines (azathioprine and 6-mercaptopurine) are the most efficient and used immunomodulators in IBD; steroid refractoriness, steroid dependency, and long-term maintenance of remission for both UC and CD are their main indications. Methotrexate and infliximab may be used in the same clinical settings as thiopurines in CD, but not in UC; however, these drugs are a second-line treatment because of safety profile and economic costs.

Decoy oligodeoxynucleotide targeting activator protein-1 (AP-1) attenuates intestinal inflammation in murine experimental colitis

“…Although the development of therapeutic monoclonal antibodies is one of the most important advances in the care of IBD patients during the past decade, current therapies based on such biological agents are not entirely as effective as expected, as several untoward effects including immunogenicity, infusion reactions, and other serious adverse events have been reported. 13,16,17 Therefore, experimental approaches to develop new therapeutic options for IBD are encouraged.…”

“…Conventional therapies for IBD focus on suppression and control of inflammation using 5-aminosalicylates, corticosteroids, and immune-modulating drugs, such as azathioprine and mercaptopurine. [10][11][12][13][14] On the other hand, recently developed novel cytokine antagonist therapies targeting TNF-a and IL-6 have been found to be quite effective in certain IBD patients. [15][16][17][18] Such molecular targeted inhibition of inflammatory processes may provide better therapeutic options for IBD and studies have been conducted to evaluate new innovative approaches.…”

MFG-E8 Attenuates Intestinal Inflammation in Murine Experimental Colitis by Modulating Osteopontin-Dependent αvβ3 Integrin Signaling

“…Considering these inflammatory consequences, several conventional therapeutic approaches for IBD, mainly based on suppression and control of inflammation, have been proposed (8 -10). Also, recently developed novel cytokine antagonist therapies have been found to be effective in certain IBD patients (11)(12)(13). Such molecular targeted inhibition of the inflammatory process may provide better therapeutic options for IBD, and various studies have been conducted to evaluate new innovative approaches.…”

Glucocorticoids differentially regulate Na-bile acid cotransport in normal and chronically inflamed rabbit ileal villus cells

“…MP inhibits many of the major immune pathways (13,51). MP and other glucocorticoids have been shown to reverse the inhibition of nutrient and electrolyte malabsorption in animal models of IBD or Crohn's disease (7,10,16,17,30,32,33,36,43,46). For example, we have demonstrated that SGLT1 (43), ASCT1 (46), and the Na-K-ATPase inhibition (43,46) are reversed by MP in a rabbit model of chronic ileal inflammation.…”