Med. praxi. 2011;8(9):360-363 [Prakt. lékáren. 2009; 5(4): 164-167]

Drug treatment options for Crohn’s disease and ulcerative colitis

prof.MUDr.Milan Lukáš, CSc.

Klinické a výzkumné centrum pro střevní záněty, ISCARE Lighthouse a 1. LF UK, Praha

Ústav klinické biochemie a laboratorní diagnostiky 1. LF UK, Praha

The options of medicamentous therapy in Crohn´s disease and ulcerative colitis aminosalicylates, corticosteroids, immunosuppressants,

and recently also biological therapy are the mainstays of pharmacotherapy of inflammatory bowel diseases (IBD). Aminosalicylates

(sulphasalazine, mesalazine) are essential drugs for both induction and maintenance treatments of patients with ulcerative colitis. They

are administered orally, in limited disease they may also be administered locally in the form of suppositorias or enemas or rectal foams.

Corticosteroids with systemic effect have a strong anti-inflammatory effect and are used in oral or parenteral therapy in patients with

a severe course of Crohn´s disease and ulcerative colitis. Treatment with corticosteroids is burdened with a risk of serious adverse effects

the intensity of which increases with the dose and duration of administration. It has been shown, that corticosteroids have no effect as

a maintenance therapy in preventing the relapse of IBD. The topical steroid (budesonide) is the first choice of therapy in patients with

ileocaecal Crohn‘s disease with a mild to moderate inflammatory activity. Immunosuppressants, particularly thiopurines, are indicated

in the treatment of chronically active course of IBD, in the case of some extraintestinal manifestations, and in patients with perianal fistulating

Crohn‘s disease. They are used particularly in practice due to its corticosteroids-sparing effect. In the last ten years, the options

of medical treatment for IBD have been broadened by biological therapy (infliximab and adalimumab). There are chimeric or human

immunoglobulins target to the tumor necrotising factor alpha, which is released from activated leucocytes during inflammatory pathway

in tissue or into circulation. In a high proportion of patients (80%-90%) unresponsive to conventional treatment with corticosteroids and

immunosuppressants, are significantly improved after biological therapy has been started.

Keywords: Crohn´s disease, ulcerative colitis, aminosalicylates, corticosteroids, immunosuppressants, biologicals

Published: September 15, 2011  Show citation