Risks and benefits of inflammatory bowel disease therapy

Question 1

What are the 5 options we have for treating IBD?

Answer 1

1. 5-ASAs
2. Antibiotics
3. Corticosteroids
4. Immunomodulators
5. Biologics (antibodies)

Question 2

What are the primary cells modulating crohns? how about UC?

Answer 2

1. Crohn’s=CD4+ T cell Th1

2. UC=CD4+ T cell Th2

Question 3

What are the three ways in which drugs can modulate the immune system?

Answer 3

Corticosteroids block the trafficking of neutrophils to the gut mucosa

Methotrexate/6MP block the proliferation of T cells through inhibiting purine synthesis. Cyclosporine and tacrolimus inhibit IL-2 signals

ADAs and biologics work by inhibiting T cell regulation through cytokines

Question 4

Which type of IBD is mesalamine (5-ASA) effective for?

Answer 4

ulcerative colitis, NOT crohn’s

Question 5

What is the most effective therapy for IBD?

Answer 5

Combo Azathioprine plus infliximab

Question 6

Why might a patient not want to take a combo therapy?

Answer 6

They hear about a serious adverse event, but the risks are small. Risks of everyday life are higher than risks of taking their medications.