6.5 Treatment of Inflammatory Bowel Disorders

Question 1

What are biologics?

Answer 1

Medications derived from (or containing components of) a living organism

Question 2

There are 4 tiers of therapeutic outcomes we aim for in IBD treatment. What are they, from first to last?

Answer 2

1. Symptomatic relief
2. Symptomatic remission/normalisation of inflammatory markers
3. Decrease in calprotectin, normal growth in children
4. Endoscopic healing

Question 3

Methotrexate mechanism in IBD

Answer 3

• Inhibits adenosine metabolism
• Causes buildup of adenosine (which is anti-inflammatory)
• Anti-inflammatory effect prevents T cell rxn, thus helping to stop autoimmunity
• Also stops cells from using folic acid to undergo DNA synthesis - T cells can’t replicate

Question 4

What is the main difference between prednisolone and budesonide?

Answer 4

Budesonide is gut selective (good first-pass liver metabolism)

Question 5

How do thiopurines help IBD? What are the risks that come with this?

Answer 5

• Systemic immunosuppressant; weaken autoimmune response on gut
• Comes with increase risk of infection, and small increase risk of malignancy

Question 6

What drug class starting with A is used to reduce the inflammatory autoimmune response in IBD? What is the most commonly used drug in this class?

Answer 6

• Aminosalicylates
• Sulfasalazine is one good example

Question 7

What is the suffix for small molecule biologics?

Answer 7

-nib

Question 8

List 5 classes of emerging biologic therapies for IBD

Answer 8

• Anti-TNFs
  -Anti-IL-23
• Anti- alpha 4 beta 7
• JAK inhibitors
• S1P blockers (keep lymphocytes inside lymph nodes)