Advanced Therapy for Inflammatory Bowel Disease
Advanced Therapy for Inflammatory Bowel Disease
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.
Primary care physicians will care for patients with inflammatory bowel disease (IBD) who are receiving advanced therapies that include immunomodulator and biologic therapy (Table 1). These agents significantly improve remission rates and 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. The purpose of this article is to provide background on these medications to the primary care provider. The need for systemic steroids should prompt gastroenterologists to consider immunomodulator or biologic therapy for optimal disease control. While systemic steroids classically are used to treat acute exacerbations of IBD, they are ineffective in maintaining remission. Furthermore, the side effect profile of corticosteroids prohibits their long-term use.
The traditional treatment algorithm for IBD follows a step-wise treatment approach, with intensified treatments used in sequence if remission is not achieved with an earlier treatment (Figure 1). Recent data, however, suggests that the early initiation of biologic therapy can modify disease progression. The efficacy of biologics has shifted the treatment paradigm, allowing gastroenterologists to incorporate more aggressive treatments early in the course of disease to alter the natural history of IBD. Immunomodulator drugs often are combined with biologics in patients with aggressive disease; a recent landmark study has illustrated a synergistic effect of these agents, which can be used indefinitely to maintain remission.
(Enlarge Image)
Figure 1.
A simplified approach to "step-wise" treatment of inflammatory bowel disease. 5-ASA, 5-aminosalicylic acid.
Abstract and Introduction
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.
Introduction
Primary care physicians will care for patients with inflammatory bowel disease (IBD) who are receiving advanced therapies that include immunomodulator and biologic therapy (Table 1). These agents significantly improve remission rates and 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. The purpose of this article is to provide background on these medications to the primary care provider. The need for systemic steroids should prompt gastroenterologists to consider immunomodulator or biologic therapy for optimal disease control. While systemic steroids classically are used to treat acute exacerbations of IBD, they are ineffective in maintaining remission. Furthermore, the side effect profile of corticosteroids prohibits their long-term use.
The traditional treatment algorithm for IBD follows a step-wise treatment approach, with intensified treatments used in sequence if remission is not achieved with an earlier treatment (Figure 1). Recent data, however, suggests that the early initiation of biologic therapy can modify disease progression. The efficacy of biologics has shifted the treatment paradigm, allowing gastroenterologists to incorporate more aggressive treatments early in the course of disease to alter the natural history of IBD. Immunomodulator drugs often are combined with biologics in patients with aggressive disease; a recent landmark study has illustrated a synergistic effect of these agents, which can be used indefinitely to maintain remission.
(Enlarge Image)
Figure 1.
A simplified approach to "step-wise" treatment of inflammatory bowel disease. 5-ASA, 5-aminosalicylic acid.