Review of Pharmacology - 9E (2015)

Review of Pharmacology
Glucocorticoids
• Prednisone, prednisolone, hydrocortisone and budesonide are used in the
treatment of moderate to severe ulcerative colitis and Crohn’s disease.
• Purine analogs
• Azathioprine and 6-MP are important agents for the induction and maintenance of
remission of ulcerative colitis and Crohn’s disease.
Methotrexate
• It is used for the induction and maintenance of remission of Crohn’s disease but not
ulcerative colitis.
Anti TNF-a therapy
• Infliximab, adalimumab and certolizumab are useful in Crohn’s disease. Efficacy
in ulcerative colitis is doubtful. Infliximab is given by i.v. route whereas other two
are administered s.c. Certolizumab is a pegylated anti-TNF-α indicated for crohn’s
disease.
Gastrointestinal Tract
Monoclonal Antibodies for
Crohn’s Disease
• Infliximab
• Adalimumab
• Certolizumab
• Natalizumab
• Vedolizumab
Anti-Integrin Therapy
• Natalizumab is recently approved for moderate to severe Crohn’s disease not
responding to other therapies. It is targeted against α 4
subunit of integrins. The
patient on natalizumab therapy should not be on other immunosuppressants due to
risk of progressive multifocal leukoencephalopathy (PML).
• Vedolizumab is a new anti-integrin that block α4 b7 in GIT but not in brain. It is,
thus, less likely to cause PML.
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