IBD

Question 1

IBD drugs

Answer 1

Crohn’s
*Methotrexate -

UC

• Aminosalicylates
• Cyclosporin

Both

• Corticosteroids
• Thiopurines

Question 2

Mechanism of action of aminosalicylates

Answer 2

Sulfalazine, mesalazine

Used to achieve remission in UC. May have benefits in crohn’s but evidence is weak.

Anti-inflammatory effects through modulation of cytokine release in colonic mucosa

Question 3

Mechanism of action of MTX

Answer 3

Used in refractory crohn’s.

Dihydrofolate reducatse inhibitor - limits formaiton of tetrahydrofolate (active form of folate)
Impaired DNA synthesis - anti-inflammatory effects

Needs folic acid supplementation

Question 4

Mechanism of action of thiopurines

Answer 4

Azathioprine, mercaptopurine

Used for refractory or frequently relapsing Crohn’s or UC.

Purine synthesis inhibitors - impaired DNA and gene synthesis. Anti-inflammatory and immunosuppressive effects

Question 5

Mechanism of action of infliximab/ adulimumab

Answer 5

Monoclonal antibodies against TNF alpha. Induces inflammatory cell apoptosis.

Indicated for moderate to severe cases of fisulating Crohn’s or severe UC that is refractory to treatment.

Question 6

Mechanism of action of corticosteroids

Answer 6

Prednisolone

Used to achieve remission principally in crohn’s and UC.

Induces synthesis of lipocortin - phospholipase A2 inhibitor.