Azathioprine or 6-mercaptopurine for induction of remission in Crohn's disease

Chande, Nilesh; Townsend, Cassandra M; Parker, Claire E; MacDonald, John K

doi:10.1002/14651858.cd000545.pub5

Cited by 63 publications

(54 citation statements)

References 80 publications

(23 reference statements)

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“…Overall, serious adverse events were reported in 14% of patients receiving AZA compared with 4% of those receiving the placebo. Common adverse events included allergic reactions, leukopenia, pancreatitis, and nausea …”

Section: Introductionmentioning

confidence: 99%

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

Ilan

2018

Journal of Leukocyte Biology

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Immune modulating treatments are often associated with immune suppression or an opposing anti‐inflammatory paradigm. As such, there is a risk of exposing patients to infections and malignancies. Contrarily, eliciting only mild immune modulation can be insufficient for alleviating immune‐mediated damage. Oral immunotherapy is a novel approach that uses the inherent ability of the gut immune system to generate signals that specifically suppress inflammation at affected sites, without inducing generalized immune suppression. Oral immunotherapy is being developed as a method to rebalance systemic immunity and restore balance, getting it back on track, rather than pushing the immune response too much or too little in opposing directions. Here, I review recent preclinical and clinical data examining the technique and describe its primary advantages.

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Section: Introductionmentioning

confidence: 99%

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

Ilan

2018

Journal of Leukocyte Biology

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“…While the IMMs are generally ineffective agents for induction of response or remission in IBD[1] the thiopurines 6MP/AZA have proven to be effective for the maintenance of response and remission in CD and UC[1,2] while the purine analogue MTX appears to offer the same benefit for CD[3]. Beginning in the 1990’s, biologic therapies targeting tumor necrosis factor alpha (TNF-α) entered into this paradigm.…”

Section: Introductionmentioning

confidence: 99%

Combination therapy for inflammatory bowel disease

Sultan

Berkowitz

Khan

2017

WJGPT

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Biologic therapies such as infliximab and adalimumab have become mainstays of treatment for inflammatory bowel disease. Early studies suggested that combination therapy (CT) with infliximab and an immunomodulator drug such as azathioprine may help optimize biologic pharmacokinetics, minimize immunogenicity, and improve outcomes. The landmark SONIC trial in Crohn’s disease and the UC SUCCESS trial in ulcerative colitis demonstrated CT with infliximab and azathioprine to be superior to monotherapy with either agent alone at inducing clinical remission in treatment naïve patients with moderate to severe disease. However, many unanswered questions linger. The role of CT in non-naive patients as well as the optimal duration of CT remains unknown. The effectiveness of CT with alternate biologics and/or alternate immunomodulators is not as clear, and it is unknown whether SONIC’s conclusions can be extrapolated beyond infliximab and azathioprine. Also looming are the risks of CT including opportunistic infection and malignancy; specifically, lymphoma. This review lays out the evidence as it pertains to the risks and benefits of CT as well as the areas that require further research. With this information in hand, the practitioner may develop a treatment strategy that best suits each individual patient.

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“…Due to its great effect latency, these drugs are not suitable to treat flares of CD [29] but can maintain remission in a fraction of CD patients [30, 31]. Typical side effects of thiopurines are, for example, fatigue, acute pancreatitis, increased susceptibility for infections and in the long-term potentially lymphoma and non-melanoma skin cancer [8, 32].…”

Section: Approved Substances – State Of the Artmentioning

confidence: 99%

Treatment Perspectives in Crohn’s Disease

Vetter¹

2018

Digestion

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Background: Crohn’s disease (CD) is a chronic immune-mediated disorder of the gastrointestinal tract. The pathophysiological understanding of this disease is limited and no curative therapy is available so far. Therefore, most patients require long-lasting or even life-long immunosuppressive therapies for the suppression of symptoms to improve quality of life and reduction of long-term risks. However, in a relevant subgroup of patients, these therapeutic goals cannot be sufficiently attained. Summary: Clinically established therapies in active CD comprise corticosteroids and immunosuppressants such as azathioprine. After the introduction of anti-TNFα (Tumor necrosis factor alpha) antibodies, other biologicals (e.g., vedolizumab and ustekinumab) have also been approved. New drugs in the pipeline like filgotinib, upadacitinib, risankizumab or rifaximin could improve the therapy of CD in the near future. Thus, an individualized therapy management, based on optimal selection of therapeutic agents will become more important. Additionally, the local application of mesenchymal stem cells might be helpful in the management of fistulas. Key Messages: The targeted biological therapeutic agents (anti-TNFα antibodies, vedolizumab, ustekinumab) are well established for therapy in CD. There are several new substances in the pipeline with promising results in phase II trials (filgotinib, rifaximin, risankizumab, upadacitinib). The upcoming extension of the therapeutic arsenal will require methods for an optimized selection of substances, thus enabling a more individualized therapy.

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Azathioprine or 6-mercaptopurine for induction of remission in Crohn's disease

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 63 publications

References 80 publications

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

Combination therapy for inflammatory bowel disease

Treatment Perspectives in Crohn’s Disease

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