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World J Gastroenterol. Mar 28, 2014; 20(12): 3146-3152
Published online Mar 28, 2014. doi: 10.3748/wjg.v20.i12.3146
Immunosuppressive therapies for inflammatory bowel disease
Talia Zenlea, Mark A Peppercorn
Talia Zenlea, Center for Women’s Gastrointestinal Medicine, The Women’s Medicine Collaborative, Alpert Medical School, Brown University, Providence, RI 02912, United States
Mark A Peppercorn, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
Author contributions: Zenlea T primarily wrote the manuscript; Peppercorn MA primarily reviewed and edited it.
Correspondence to: Talia Zenlea, MD, Director of Inflammatory Bowel Diseases, Center for Women’s Gastrointestinal Medicine, The Women’s Medicine Collaborative, Alpert Medical School, Brown University, 146 West River St, Providence, RI 02904, United States. taliazenlea@gmail.com
Telephone: +1-401-7937080 Fax: +1-401-7937801
Received: September 28, 2013
Revised: January 4, 2014
Accepted: January 19, 2014
Published online: March 28, 2014
Abstract

Inflammatory bowel disease (IBD) is comprised of Crohn’s disease and ulcerative colitis, both chronic inflammatory intestinal disorders of unknown etiology characterized by a waxing and waning clinical course. For many years, the drug therapy was limited to sulfasalazine and related aminosalicylates, corticosteroids and antibiotics. Studies suggesting that the pathophysiology of these disorders relates to a disregulated, over-active immune response to indigenous bacteria have led to the increasing importance of immunosuppressive drugs for the therapy of IBD. This review details the mechanisms of action, clinical efficacy, and adverse effects of these agents.

Keywords: Crohn’s disease, Ulcerative colitis, Inflammatory bowel disease, Immunosuppressives, Tumor necrosis factor inhibitors

Core tip: This manuscript reviews the current status of immunosuppressive therapy for inflammatory bowel disease. It describes the mechanism of action, clinical efficacy and adverse effects of immunomodulators including azathioprine, 6-mercaptopurine, methotrexate, and cyclosporine and biologics including anti-tumor necrosis factor (TNF) agents and adhesion molecule inhibitors. It emphasizes the role of azathioprine, 6-mercaptopurine, and methotrexate in the long-term maintenance of Crohn’s disease, the utility of cyclosporine in severe refractory ulcerative colitis and the unique role of anti-TNF agents in the remission induction and maintenance of difficult to treat patients with Crohn’s disease and ulcerative colitis.