Managing refractory Crohn's disease: challenges and solutions
Satoshi Tanida, Keiji Ozeki, Tsutomu Mizoshita, Hironobu Tsukamoto, Takahito Katano, Hiromi Kataoka, Takeshi Kamiya, Takashi Joh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi Prefecture, Japan Abstract: The goals of treatment for ac...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2015-04-01
|
| Series: | Clinical and Experimental Gastroenterology |
| Online Access: | http://www.dovepress.com/managing-refractory-crohn39s-disease-challenges-and-solutions-peer-reviewed-article-CEG |
| _version_ | 1811248069464817664 |
|---|---|
| author | Tanida S Ozeki K Mizoshita T Tsukamoto H Katano T Kataoka H Kamiya T Joh T |
| author_facet | Tanida S Ozeki K Mizoshita T Tsukamoto H Katano T Kataoka H Kamiya T Joh T |
| author_sort | Tanida S |
| collection | DOAJ |
| description | Satoshi Tanida, Keiji Ozeki, Tsutomu Mizoshita, Hironobu Tsukamoto, Takahito Katano, Hiromi Kataoka, Takeshi Kamiya, Takashi Joh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi Prefecture, Japan Abstract: The goals of treatment for active Crohn's disease (CD) are to achieve clinical remission and improve quality of life. Conventional therapeutics for moderate-to-severe CD include 5-aminosalicylic acid, corticosteroids, purine analogs, azathioprine, and 6-mercaptopurine. Patients who fail to respond to conventional therapy are treated with tumor necrosis factor (TNF)-α inhibitors such as infliximab and adalimumab, but their efficacy is limited due to primary nonresponse or loss of response. It is suggested that this requires switch to another TNF-α inhibitor, a combination therapy with TNF-α blockade plus azathioprine, or granulocyte and monocyte adsorptive apheresis, and that other therapeutic options having different mechanisms of action, such as blockade of inflammatory cytokines or adhesion molecules, are needed. Natalizumab and vedolizumab are neutralizing antibodies directed against integrin a4 and a4ß7, respectively. Ustekinumab is a neutralizing antibody directed against the receptors for interleukin-12 and interleukin-23. Here, we provide an overview of therapeutic treatments that are effective and currently available for CD patients, as well as some that likely will be available in the near future. We also discuss the advantages of managing patients with refractory CD using a combination of TNF-α inhibitors plus azathioprine or intensive monocyte adsorptive apheresis. Keywords: adalimumab, granulocyte and monocyte adsorptive apheresis, combination therapy, complete remission |
| first_indexed | 2024-04-12T15:20:27Z |
| format | Article |
| id | doaj.art-55952f04abef46b0b6cb666adcb88dd0 |
| institution | Directory Open Access Journal |
| issn | 1178-7023 |
| language | English |
| last_indexed | 2024-04-12T15:20:27Z |
| publishDate | 2015-04-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical and Experimental Gastroenterology |
| spelling | doaj.art-55952f04abef46b0b6cb666adcb88dd02022-12-22T03:27:28ZengDove Medical PressClinical and Experimental Gastroenterology1178-70232015-04-012015default13114021263Managing refractory Crohn's disease: challenges and solutionsTanida SOzeki KMizoshita TTsukamoto HKatano TKataoka HKamiya TJoh TSatoshi Tanida, Keiji Ozeki, Tsutomu Mizoshita, Hironobu Tsukamoto, Takahito Katano, Hiromi Kataoka, Takeshi Kamiya, Takashi Joh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi Prefecture, Japan Abstract: The goals of treatment for active Crohn's disease (CD) are to achieve clinical remission and improve quality of life. Conventional therapeutics for moderate-to-severe CD include 5-aminosalicylic acid, corticosteroids, purine analogs, azathioprine, and 6-mercaptopurine. Patients who fail to respond to conventional therapy are treated with tumor necrosis factor (TNF)-α inhibitors such as infliximab and adalimumab, but their efficacy is limited due to primary nonresponse or loss of response. It is suggested that this requires switch to another TNF-α inhibitor, a combination therapy with TNF-α blockade plus azathioprine, or granulocyte and monocyte adsorptive apheresis, and that other therapeutic options having different mechanisms of action, such as blockade of inflammatory cytokines or adhesion molecules, are needed. Natalizumab and vedolizumab are neutralizing antibodies directed against integrin a4 and a4ß7, respectively. Ustekinumab is a neutralizing antibody directed against the receptors for interleukin-12 and interleukin-23. Here, we provide an overview of therapeutic treatments that are effective and currently available for CD patients, as well as some that likely will be available in the near future. We also discuss the advantages of managing patients with refractory CD using a combination of TNF-α inhibitors plus azathioprine or intensive monocyte adsorptive apheresis. Keywords: adalimumab, granulocyte and monocyte adsorptive apheresis, combination therapy, complete remissionhttp://www.dovepress.com/managing-refractory-crohn39s-disease-challenges-and-solutions-peer-reviewed-article-CEG |
| spellingShingle | Tanida S Ozeki K Mizoshita T Tsukamoto H Katano T Kataoka H Kamiya T Joh T Managing refractory Crohn's disease: challenges and solutions Clinical and Experimental Gastroenterology |
| title | Managing refractory Crohn's disease: challenges and solutions |
| title_full | Managing refractory Crohn's disease: challenges and solutions |
| title_fullStr | Managing refractory Crohn's disease: challenges and solutions |
| title_full_unstemmed | Managing refractory Crohn's disease: challenges and solutions |
| title_short | Managing refractory Crohn's disease: challenges and solutions |
| title_sort | managing refractory crohn 39 s disease challenges and solutions |
| url | http://www.dovepress.com/managing-refractory-crohn39s-disease-challenges-and-solutions-peer-reviewed-article-CEG |
| work_keys_str_mv | AT tanidas managingrefractorycrohn39sdiseasechallengesandsolutions AT ozekik managingrefractorycrohn39sdiseasechallengesandsolutions AT mizoshitat managingrefractorycrohn39sdiseasechallengesandsolutions AT tsukamotoh managingrefractorycrohn39sdiseasechallengesandsolutions AT katanot managingrefractorycrohn39sdiseasechallengesandsolutions AT kataokah managingrefractorycrohn39sdiseasechallengesandsolutions AT kamiyat managingrefractorycrohn39sdiseasechallengesandsolutions AT joht managingrefractorycrohn39sdiseasechallengesandsolutions |