Drugs used for inflammatory bowel disease.pdf

Inflammatory bowel disease ppt

1. VAISHNAVI VS
142
DRUGS USED
FOR
INFLAMMATORY
BOWEL DISEASE

2. Inflammatory bowel disease is a chronic relapsing inflammatory disease of the
ileum, colon, or both that may be associated with systemic manifestations.
It is idiopathic but appears to have an important immune component
triggered by a variety of factors.
Extrahepatic manifestations like fever, oral ulceration, arthritis, dermatitis,
hepatitis, uvetitis etc can accompany.
IBD
Two Major types
Ulcerative colitis(UC)
Crohn’s Disease(CrD)

3. 5-
Aminosalicylic
acid(5-ASA)
compounds Corticosteroids
Immunosuppressants
TNFα
Inhibitors
Sulfasalazine
Mesalamine
Olsalazine
Balsalazide
Prednisolone
Methylprednisolone
Hydrocortisone
Budesonide
Azathioprine
6-mercaptopurine
Methotrexate
Cyclosporine
Infliximab
Adalimumab
DRUGS FOR IFB

4. It is a prodrug, a compound of 5-aminosalicylic acid with sulfapyridine
linked through an azo bond and has a specific therapeutic effect in IBD.
It also used as disease modifying drug in rheumatoid arthritis.
On oral administration, Sulfasalazine azo bond is split by colonic
bacteria to release 5-ASA and sulfapyridine.
5-ASA Compounds
Sulfasalazine

5. The released 5-ASA acts locally and inhibits COX and LOX- Decreased
prostaglandins and leukotrienes. Inhibition of cytokines, PAF, TNFα and nuclear
transcription factor.
Migration of inflammatory cells like neutrophils into bowel wall is interferred
Mucosal secretion is reduced.
Symptomatic relief in Ulcerative colitis only( since sulfasalazine releases 5-ASA
only in colon)
Side effects - Most of the released sulfapyridine gets absorbed and
causes rashes, fever, joint pain, hemolysis and blood dyscarsias.
Mild anemia, nausea, vomiting, headache and malaise may also occur.
Sulfasalazine interferes with Folic acid absorption. So folic acid
supplementation should always be given during its use.

6. Mesalamine
It is 5-ASA.
Well absorbed in upper
GIT,
Therefore, given as
special
formulations(delayed
release or pH dependent
tablets)
Can be administered as
suppository or enema.
Olsalazine
Composed of two
molecules of 5-ASA with
an azo linkage.
Poorly absorbed after oral
administration.
In the colon, it is cleaved
into two molecules of 5-
ASA by colonic bacteria.
Balsalazide
This is a 5-ASA linked to
4-aminobenzoyl-β-
alanine. as a carrier,
unlike sulfapyridine, is
inert.
Used as a safe
alternative to
sulfasalazine.
Mesalamine, Olsalazine and Balsalazide have lower incidence of side effects than
sulfasalazine.
5-ASA Compounds are mostly used for treatment of Ulcerative colitis and colon
restricted Crohn’s disease . The current treatment guidelines donot recommend their
use in CrD.

7. Glucocorticoids are the drugs of choice for moderately severe exacerbations and
in patients who do not respond to 5-ASA compounds.
Highly effective in controlling symptoms as well as in inducing remission in both UC
and CrD.
Prolonged use of glucocorticoids can lead to hypothalamic-pituitary-adrenal axis
suppression and other side effects like osteoporosis, peptic ulcer, infections and
hyperglycemia.
Glucocorticoids
Various glucocorticoids used are:
Prednisolone(oral)
Methylprednisolone(oral, parenteral)
Hydrocortisone(enema, suppository)
Budesonide(oral)

8. Purine antimetabolite , most effective and
commonly used immunosuppressant in IBD.
6-Mercaptopurine can be used in its place.
It is used for steroid dependent, steroid
resistant and severe cases of IBD.
Azathioprine
Methotrexate
DHF reductase inhibitor with
immunosuppressant and
antiinflammatory property.
2nd line drug in IBD.
Used in patients not responsive or not
tolerating azathioprine.
IMMUNOSUPPRESSANTS
Important role in Long term management of IBD especially CrD.
Long Latency period Not suitable for acute episodes
Has good remission maintaining and steroid-sparing property.

9. TNFα inhibitors can be used in severe cases of Crohn’s disease
and refractory ulcerative colitis and cases which hasn’t
improved with usage of immunosuppressants and
corticosteroids.
Disadvantages
Higher cost
Increased susceptibility to infections.
TNFα Inhibitors
Examples - Infliximab, Adalimumab.

10. Antibiotics
Probiotics
Metronidazole
Ciprofloxacin
Clarithromycin
Used as adjuncts in patients
with active Crohn’s disease.
Probiotics help to restore the
intestinal flora
Useful as adjunct therapy in patients
with severe IBD.
Eg: Lactobacillus, Bacteroides.

11. Conclusion.
Inflammatory bowel disease includes
Crohn’s disease and Ulcerative colitis,
which is characterized by diarrhoea,
bleeding, abdominal pain, anemia and
weight loss.
Commonly used drugs are
aminosalicylates, glucocorticoids,
immunosuppressants, TNFα inhibitors,
antibiotics and probiotics.
First line of drugs used are 5-ASAs.