Published online Feb 7, 2014. doi: 10.3748/wjg.v20.i5.1248
Revised: November 5, 2013
Accepted: December 12, 2013
Published online: February 7, 2014
The inflammatory bowel diseases (IBDs) are chronic incurable conditions that primarily present in young patients. Being incurable, the IBDs may be part of the patient’s life for many years and these conditions require therapies that will be effective over the long-term. Surgery in Crohn’s disease does not cure the disease with endoscopic recurrent in up to 70% of patients 1 year post resection. This means that, the patient will require many years of medications and the goal of the treating physician is to induce and maintain long-term remission without side effects. The development of the anti-tumour necrosis factor alpha (TNFα) agents has been a magnificent clinical advance in IBD, but they are not always effective, with loss of response overtime and, at times, discontinuation is required secondary to side effects. So what options are available if of the anti-TNFα agents can no longer be used? This review aims to provide other options for the physician, to remind them of the older established medications like azathioprine/6-mercaptopurine and methotrexate, the less established medications like mycophenolate mofetil and tacrolimus as well as newer therapeutic options like the anti-integins, which block the trafficking of leukocytes into the intestinal mucosa. The location of the intestinal inflammation must also be considered, as topical therapeutic agents may also be worthwhile to consider in the long-term management of the more challenging IBD patient. The more options that are available the more likely the patient will be able to have tailored therapy to treat their disease and a better long-term outcome.
Core tip: Overall the physician must keep an open mind when treating inflammatory bowel disease. These patients have a long-term incurable condition than can significantly impact on all aspects of their life. Surgery does not cure the disease and thus medications may be required for many decades in order to give the patients a decent quality of life. Both the patient and the physician, therefore, need to remember the “oldies but goodies” but also keep the door open to new innovations and novel therapies.