Immunosuppressants ulcerative colitis

Maintenance of remission of ulcerative colitis may be achieved with oral or topical aminosalicylates. Immunosuppressants such as azathioprine or 6-mercaptopurine can be used for unresponsive patients or those who develop corticosteroid dependency. 

Immunosuppressive agents such as azathioprine and mercaptopurine (a metabohte of azathioprine) are sometimes used for the treatment of IBD. These agents are generally reserved for cases that are refractory to steroids and may be associated with serious adverse effects such as lymphomas, pancreatitis, or nephrotoxicity. Cyclosporine has been of short-term benefit in acute, severe ulcerative colitis when used in a continuous infusion. 

Infliximab is a monoclonal antibody against TNF-a (see Chapter 26, Section III.d.1). It has been approved for the treatment of psoriasis, Crohn s disease, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis and ulcerative colitis. Similar immunosuppressants are etanercept, and adali-mumab. 

Treatments are broadly the same as for ulcerative colitis being based on appropriate supportive measures, and the use of corticosteroids, the cytokine infliximab or adalimumab for severe and complicated disease and immunosuppressants, typically azathio-prine, for reducing the chances of relapse. Full thickness disease leading to flstulation, free perforation, abscess formation and stricturing usually requires surgery. Aminosalicylates appear ineffective in reducing the chances of relapse. 

IX.b.3.3. Immunosuppressants. As in ulcerative colitis low doses of azathioprine (2 mg/kg) are effective in preventing recurrence, but have little value in treating acute disease. 

Sands BE. Immunosuppressive drugs in ulcerative colitis twisting facts to suit theories Gut. 2006 55 437-441. 

Whilst the hazards may be acceptable to the patient who has grave life-endangering disease, they give more cause for concern when immunosuppressive regimens are proposed in younger patients with less serious disease, e.g. rheumatoid arthritis, ulcerative colitis. 

The main drugs used in the treatment of ulcerative colitis and Crohn s disease are the aminosalicylates and corticosteroids. Their mode of action is obscure. Other immunosuppressives also have a role and recent studies into the mechanisms of inflammation are leading to the introduction of novel therapies to inhibit the inflammatory process. 

Ulcerative Colitis. The use of immunosuppressive drugs (6-mercapto-purine, busulfan, 6-thioguanosine, azathioprei ) in experimental therapy of ulcerative colitis has been reported. -106 Results have been encouraging in the small group of patients tested but potentially serious side effects were observed due to the high doses that were required. Disappointing features are the failure to achieve a cvire and the severity of relapse on suspension of treatment. 

Azathioprine is indicated in renal homotransplantation (five-year patient survival rate of 35%) in rheumatoid arthritis (for patients with severe, active, and erosive disease not responding to conventional therapies) and in chronic ulcerative colitis, myasthenia gravis, and Behcet s syndrome (adverse effects may offset its limited value). As with other cytotoxic drugs, azathioprine can affect rapidly growing cells, resulting in leukopenia, thrombocytopenia, and gastrointestinal toxicity. In addition, hepatotoxicity (cholestasis) has been reported. Many of the general problems of immunosuppression, such as increased risk of infections, can also occur. 

The client diagnosed with severe ulcerative colitis is prescribed azathioprine (Imuran), an immunosuppressant. Which assessment data concerning the medication would warrant immediate intervention by the nurse ... 

Infection risk Fatal Pneumocystis jirovecii pneumonia complicated immunosuppressive therapy in two patients with steroid-refractory ulcerative colitis taking steroids and tacrolimus [146" ]. Despite immediate therapy with high-dose co-trimoxazole and broad-spectrum antibiotics, both patients died with progressive respiratory failure. 

Reactivation of hepatitis B virus is a well-recognized complication in patients with chronic infection who receive immunosuppressive or cytotoxic therapy. In one case reactivation occurred after glucocorticoid treatment of ulcerative colitis and required liver transplantation [20" ]. The authors... 

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