When to Start Immunomodulators in Inflammatory Bowel Disease?

Sharara, Ala I.

doi:10.1159/000443127

Cited by 8 publications

(4 citation statements)

References 53 publications

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“…MTX is often recommended as a second-line immunomodulatory therapy. Thiopurines are typically recommended as the first line and have proven steroid-sparing effects and modest efficacy as maintenance therapy and for prevention of postoperative recurrence (76) .…”

Section: Recommendationmentioning

confidence: 99%

Brazilian Consensus on the Management of Inflammatory Bowel Diseases in Pediatric Patients: A Consensus of the Brazilian Organization for Crohn’s Disease and Colitis (Gediib)

Lomazi

Oba

Rodrigues

et al. 2023

Arq. Gastroenterol.

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Background -Approximately 25% of patients with inflammatory bowel disease (IBD) develop the disease during childhood or adolescence and treatment aims to control active symptoms and prevent long-term complications. The management of Crohn's disease (CD) and ulcerative colitis (UC) can be especially challenging in children and adolescents, related to particularities that may affect growth, development, and puberty. Objective -This consensus aims to provide guidance on the most effective medical and surgical management of pediatric patients with CD or UC. Methods -Experts in Pediatric IBD representing Brazilian gastroenterologists (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]) developed this consensus. A rapid review was performed to support the recommendations/statements. Medical and surgical recommendations were structured and mapped according to the disease type, disease activity, and indications and contraindications for medical and surgical treatment. After structuring the statements, the modified Delphi Panel methodology was used to conduct the voting. The process took place in three rounds: two using a personalized and anonymous online voting platform and one face-to-face. Whenever participants did not agree with a specific recommendation, an option to explain why was offered to enable free-text responses and provide the opportunity for the experts to elaborate or explain disagreement. The consensus of recommendations in each round was accepted when reached ≥80% agreement. Results and conclusion -The recommendations are presented according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/ patient monitoring after initial treatment, follow-up/ patient monitoring after initial treatment. Surgical recommendations were grouped according to disease type and recommended surgery. The target audience for this consensus was general practitioners, gastroenterologists, and surgeons interested in the treatment and management of pediatric CD and UC. Additionally, the consensus aimed to support the decision-making of health insurance companies, regulatory agencies, and health institutional leaders and/or administrators.

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Section: Recommendationmentioning

confidence: 99%

Brazilian Consensus on the Management of Inflammatory Bowel Diseases in Pediatric Patients: A Consensus of the Brazilian Organization for Crohn’s Disease and Colitis (Gediib)

Lomazi

Oba

Rodrigues

et al. 2023

Arq. Gastroenterol.

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“…However, concomitant administration of DMARDs such as azathioprine and methotrexate (MTX) may decrease anti-IFX and anti-ADA Abs and prolong therapeutic efficacy [2,13,14]. In patients with early Crohn's disease (CD) concomitant administration of azathioprine or MTX with IFX allows to reach significantly lower antibody levels and higher median serum trough levels of infliximab [15].…”

Section: Anti-infliximab and Anti-adalimumab Antibodiesmentioning

confidence: 99%

Immunogenicity of infliximab and adalimumab

Murdaca

Negrini

Greco

et al. 2019

Expert Opinion on Drug Safety

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“…Immunomodulators included in this review are thiopurines (6-mercaptopurine, 6-MP, and its prodrug azathioprine), methotrexate, tacrolimus, interferon, cyclosporin, and intravenous immunoglobuilin [ 41 ].…”

Section: Medical Treatmentmentioning

confidence: 99%

Updated treatment strategies for intestinal Behçet’s disease

Park

Cheon

2018

Korean J Intern Med

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Behçet’s disease (BD) is a chronic, idiopathic, relapsing immune-mediated disease involving multiple organs, and is characterized by recurrent oral and genital ulcers, ocular disease, gastrointestinal ulcers, vascular diseases, and skin lesions. In particular, gastrointestinal involvement in BD is followed by severe complications, including massive bleeding, bowel perforation, and fistula, which can lead to significant morbidity and mortality. However, the management of intestinal BD has not yet been properly established. Intestinal BD patients with a severe clinical course experience frequent disease aggravations and often require recurrent corticosteroid and/or immunomodulatory therapies, or even surgery. However, a considerable number of patients with intestinal BD are often refractory to conventional therapies such as corticosteroids and immunomodulators. Recently, there has been a line of evidence suggesting that biologics such as infliximab and adalimumab are effective in treating intestinal BD. Moreover, new biologics targeting proteins other than tumor necrosis factor α are emerging and are under active investigation. Therefore, in this paper, we review the current therapeutic strategies and new clinical data for the treatment of intestinal BD.

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When to Start Immunomodulators in Inflammatory Bowel Disease?

Cited by 8 publications

References 53 publications

Brazilian Consensus on the Management of Inflammatory Bowel Diseases in Pediatric Patients: A Consensus of the Brazilian Organization for Crohn’s Disease and Colitis (Gediib)

Brazilian Consensus on the Management of Inflammatory Bowel Diseases in Pediatric Patients: A Consensus of the Brazilian Organization for Crohn’s Disease and Colitis (Gediib)

Immunogenicity of infliximab and adalimumab

Updated treatment strategies for intestinal Behçet’s disease

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