Conventional therapy for moderate to severe inflammatory bowel disease: A systematic literature review

Abstract

BACKGROUND Despite the advent of biological drugs, conventional therapy continues to be used in moderate to severe inflammatory bowel disease (MS-IBD). This study hypothesized that as a standard of treatment and the primary alternative to biologics, conventional therapy should present robust effectiveness results in IBD outcomes. AIM To investigate the effectiveness of conventional therapy for MS-IBD. METHODS A systematic review with no time limit was conducted in July 2017 through the Cochrane Collaboration, MEDLINE, and LILACS databases. The inclusion criteria encompassed meta-analyses, systematic reviews, randomized clinical trials, observational and case-control studies concerning conventional therapy in adult patients with MS-IBD, including Crohn’s disease (CD) and ulcerative colitis (UC). Corticosteroids (prednisone, hydrocortisone, budesonide, prednisolone, dexamethasone), 5-aminosalicylic acid (5-ASA) derivatives (mesalazine and sulfasalazine) and immunosuppressants [azathioprine (AZA), methotrexate (MTX), mycophenolate, cyclosporine, tacrolimus, 6-mercaptopurine (6-MP)] were considered conventional therapy. The exclusion criteria were sample size below 50; narrative reviews; specific subpopulations ( e.g ., pregnant women, comorbidities); studies on postoperative IBD; and languages other than English, Spanish, French or Portuguese. The primary outcome measures were clinical remission (induction or maintenance), clinical response and mucosal healing. As secondary outcomes, fecal calprotectin, hospitalization, death, and surgeries were analyzed. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS The search strategy identified 1995 citations, of which 27 were considered eligible (7 meta-analyses, 20 individual studies). For induction of clinical remission, four meta-analyses were selected (AZA and 6-MP showed no advantage over placebo, MTX or 5-ASA in CD; MTX showed no statistically significant difference versus placebo, 6-MP, or 5-ASA in UC; tacrolimus was superior to placebo for UC in two meta-analyses). Only one meta-analysis evaluated clinical remission maintenance, showing no statistically significant difference between MTX and placebo, 5-ASA, or 6-MP in UC. AZA and 6-MP had no advantage over placebo in induction of clinical response in CD. Three meta-analyses showed the superiority of tacrolimus vs placebo for induction of clinical response in UC. The clinical response rates for cyclosporine were 41.7% in randomized controlled trials (RCTs) and 55.4% in non-RCTs for UC. For induction of mucosal healing, one meta-analysis showed a favorable rate with tacrolimus versus placebo for UC. For secondary outcomes, no meta-analyses specifically evaluated fecal calprotectin, hospitalization or death. Two meta-analyses were retrieved evaluating colectomy rates for tacrolimu...

Effects of kampo medicine keishikashakuyakuto on large intestine disease in mice

“…Inflammatory bowel syndrome and IBD cause frequent diarrhea, which reduces the quality of life . The kampo medicine KST has long been used for the treatment of abdominal pain caused by diarrhea.…”

“…97) exceeded 160 000 in 2013, and the number of IBD patients is increasing . Corticosteroids, 5‐aminosalicylic acid, immune modulators, such as thiopurine and methotrexate , biological drugs, and anti‐tumor necrosis factor (TNF) antibody are used for the treatment of IBD in both CD and UC patients. We previously reported that Swertia japonica extract and its main compound swertiamarine, and Atractylodes lancea rhizome extract and a volatile component β‐eudesmol stimulated gastric emptying and/or small intestine motility by inhibiting the dopamine D 2 and/or 5‐HT receptor .…”

Thiopurine Drugs in the Treatment of Ulcerative Colitis: Identification of a Novel Deleterious Mutation in TPMT

“…Cyclosporine is used in more critical UC, if intravenous steroids do not produce the desired induction of remission. Azathioprine (AZA) and 6-mercaptopurine (6-MP), two analogues of thiopurine, have been the mainstay of IBD treatment as steroid sparing agents thanks to their modulation of the immune system [ 4 , 5 ]. They are used to maintain the remission acquired during the use of corticosteroids, but especially in combination with biological therapy.…”

Inflammatory Bowel Disease and Obstructive Pulmonary Disease: A Two-way Association?

“…We wanted to explore the underlying factors leading to the relationship between these two conditions and also shed light on airway diseases as an extraintestinal manifestation of IBD [5]. We document the pathogenesis of these highly prevalent and multifaceted problems and also attempt to highlight the etiological basis of this association, the physical and psychosocial impact of the problem, and briefly discuss the pros and cons of conventional therapy versus alternative treatment [9]. We systematically review and summarize the latest database on PubMed concerning the co-occurrence of IBD and obstructive pulmonary diseases and the significant associated impact on public health and present this study to the scientific world [10].…”