Use of methotrexate in inflammatory bowel disease in 2014: A User’s Guide

Swaminath, Arun

doi:10.4292/wjgpt.v5.i3.113

Cited by 27 publications

(18 citation statements)

References 34 publications

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“…However, methotrexate can be used as an effective immune-modulator in inflammatory bowel disease. 70 Of importance to dentists, methotrexate can commonly cause ulcerative stomatitis 71 and recent case reports have identified Epstein-Barr associated lympho-proliferative disorders occurring in the gingiva of patients taking methotroxate, causing gingival ulceration. 72,73 Biologic anti-TNF agents Both infliximab and adalimumab are relatively new antibody-based drugs against TNF (tumour necrosis factor), which is a cytokine agent in the body's immune response, upregulated in inflammatory conditions such as IBD.…”

Section: Methotrexatementioning

confidence: 99%

Inflammatory bowel disease and oral health

Chandan

Thomas

2017

BDJ Team

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Risk factors involved in IBDIBD is thought to result from inappropriate and ongoing activation of the mucosal immune system facilitated by defects in both the intestinal epithelium and mucosal immune system. 5 There are both genetic and environmental factors implicated in the aetiology of IBD. 6 Although traditionally associated with the developed world, recent epidemiological studies suggest an increasing incidence in rapidly developing countries, especially in South-East Asia. 7 In addition, the increased risk of IBD in the immigrant populations in the West suggests environment has a role in the development of IBD. 8 Genetic Detailed genetic mapping has identified specific genetic changes on chromosome 16 carried in families which appear linked to CD, however no significant changes have been mapped as of yet to UC. 9,10 Specifically, variants of the NOD2 gene provide the strongest association with susceptibility to CD. NOD2 plays a key role in regulating the gut mucosal barrier involving, specifically, the microbiota, as well as the related response by the innate and adaptive immune system. The IBDchip European Project showed NOD2 has been implicated in ileal location colitis with stenosing and penetrating disease behaviour. 11 A genome wide association study has also identified a strong link between the IL23R gene and CD. 12 The gene in particular codes for interleukin 23 that plays a role in regulating innate immunity within the intestine. 13 Cigarette smoking Unusually, cigarette smoking is associated with decreased rates of incidence of UC and has been associated with protective features to prevent further flare-ups of the condition 14-19 such as relapses, 20 ©SEBASTIAN KAULITZKI/Science Photo Library/Getty J. S. Chandan 1 and T. Thomas 1 summarise the treatments for inflammatory bowel disease (IBD) and how anti-inflammatory medications can have side effects that affect the oral cavity.

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Section: Methotrexatementioning

confidence: 99%

Inflammatory bowel disease and oral health

Chandan

Thomas

2017

BDJ Team

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“…It is used predominantly for immunosuppression in autoimmune diseases and as chemotherapy. In CD it has to date remained in treatment algorithms as a salvage therapy for patients who have failed to respond or became intolerant to azathioprine [97] . However, its use is not so common in the clinical routine for CD but MTX seems to be sufficient in maintenance therapy.…”

Section: CDmentioning

confidence: 99%

“…Recently a user's guide was published which favors the safe and efficient use of MTX in several clinical conditions of CD and UC. The authors Swaminath et al [97] provided an ease to use algorithm. MTX is largely used as a second line therapy after AZA failure.…”

Section: CDmentioning

confidence: 99%

Pharmacological- and non-pharmacological therapeutic approaches in inflammatory bowel disease in adults

Leitner

Vogelsang

2016

WJGPT

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Inflammatory bowel diseases (IBDs) are a group of chronic inflammatory conditions mainly of the colon and small intestine. Crohn's disease (CD) and ulcerative colitis (UC) are the most frequent types of IBD. IBD is a complex disease which arises as a result of the interaction of environmental, genetic and immunological factors. It is increasingly thought that alterations of immunological reactions of the patients to their own enterable bacteria (microfilm) may contribute to inflammation. It is characterized by mucosal and sub mucosal inflammation, perpetuated by infiltration of activated leukocytes. CD may affect the whole gastrointestinal tract while UC only attacks the large intestine. The therapeutic goal is to achieve a steroidfree long lasting remission in both entities. UC has the possibility to be cured by a total colectomy, while CD never can be cured by any operation. A lifelong intake of drugs is mostly necessary and essential. Medical treatment of IBD has to be individualized to each patient and usually starts with anti-inflammatory drugs. The choice what kind of drugs and what route administered (oral, rectal, intravenous) depends on factors including the type, the localization, and severity of the patient's disease. IBD may require immune-suppression to control symptoms such as prednisolone, thiopurines, calcineurin or sometimes folic acid inhibitors or biologics like TNF-α inhibitors or anti-integrin antibodies. For both types of disease (CD, UC) the same drugs are available but they differ in their preference in efficacy between CD and UC as 5-aminosalicylic acid for UC or budesonide for ileocecal CD. As therapeutic alternative the main mediators of the disease, namely the activated pro-inflammatory cytokine producing leukocytes can be selectively removed via two apheresis systems (Adacolumn and Cellsorba) in steroid-refractory or dependent cases. Extracorporeal photopheresis results in an increase of regulatory B cells, regulatory CD8 + T cells and T-regs Type 1. Both types of apheresis were able to induce clinical remission and mucosal healing accompanied by tapering of steroids.

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“…However, MTX may be considered if no contraindications are present [38] . A new study by Haisma et al [39] studied the effectiveness of MTX for maintaining remission in 113 pediatric CD patients with prior failure or intolerance to TPs.…”

Section: Use In CDmentioning

confidence: 99%

“…Similarly, the recent Toronto Consensus guidelines strongly recommend against the use of MTX monotherapy for induction or maintenance of remission in UC. Two ongoing large randomized controlled trials (METEOR and MERIT-UC) are assessing the efficacy of parenteral MTX 25 mg weekly in the induction and maintenance of remission in steroid-dependent or refractory UC [38] . Preliminary results of the METEOR study on 111 patients showed improved clinical remission without steroids (42% MTX vs. 23.5% placebo, p = 0.04) but no significant effect on the primary composite end point at week 16 (32% MTX vs. 20% placebo, p = 0.15) or on mucosal healing (35% MTX vs. 25.5% placebo, p = NS) [48,49] .…”

Section: Use In CDmentioning

confidence: 99%

When to Start Immunomodulators in Inflammatory Bowel Disease?

Sharara

2016

Dig Dis

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Background: Immunomodulators (IMMs), including thiopurines (TPs) and methotrexate (MTX), are commonly used in the treatment of inflammatory bowel disease (IBD). Key Messages: In ulcerative colitis (UC), TPs have modest steroid-sparing effects and established efficacy in maintenance of remission. The role of MTX in UC is unclear but current evidence suggests no benefit over placebo. In Crohn's disease (CD), MTX is not effective for induction but has a modest steroid-sparing effect and is superior to placebo in maintenance of remission in responders. The addition of MTX to infliximab reduces immunogenicity and boosts infliximab levels but does not improve outcomes in active CD. TPs are not effective for induction of remission in CD but have proven steroid-sparing effects and modest efficacy in maintenance of remission and prevention of postoperative recurrence. Although effective in pediatric CD, recent evidence has questioned the benefit of early TPs in newly diagnosed adult CD. The addition of TPs to infliximab reduces immunogenicity and inflammatory markers, leads to higher infliximab levels and improves outcomes in patients with early disease. However, the benefit of continued TP therapy in this setting is unclear and should be weighed against possible side effects including an increased risk of opportunistic infections, lymphoma and non-melanoma skin cancer. Conclusions: IMMs are an important therapeutic option in IBD particularly in non-severe steroid-dependent disease and for maintenance of remission. Combination with anti-TNF agents is an important emerging option as part of a treat-to-target strategy but further research regarding patient selection, long-term use and de-escalation options is needed.

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Use of methotrexate in inflammatory bowel disease in 2014: A User’s Guide

Cited by 27 publications

References 34 publications

Inflammatory bowel disease and oral health

Inflammatory bowel disease and oral health

Pharmacological- and non-pharmacological therapeutic approaches in inflammatory bowel disease in adults

When to Start Immunomodulators in Inflammatory Bowel Disease?

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