mercaptopurine and tofacitinib

This article reviews nonbiologic immunosuppressive agents in the induction and maintenance of remission of ulcerative colitis. Based on meta-analyses and North American guidelines, azathioprine, mercaptopurine, and methotrexate monotherapy are not recommended for induction therapy. Thiopurines are recommended in combination with infliximab. Tofacitinib has been shown to be an effective induction agent. Cyclosporine or tacrolimus are calcineurin inhibitors that can be used as induction therapy. Thiopurine monotherapy is suggested or recommended as maintenance therapy for patients who have achieved steroid-induced remission. Methotrexate monotherapy is not recommended. Tofacitinib has been shown to be an effective maintenance agent in moderate to severe disease.

Topics: Azathioprine; Colitis, Ulcerative; Contraindications, Drug; Glucocorticoids; Humans; Immunosuppressive Agents; Maintenance Chemotherapy; Mercaptopurine; Meta-Analysis as Topic; Methotrexate; Piperidines; Pyrimidines; Remission Induction

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that is chronically present in patients throughout their lives. Hence, the chronic nature of the disease invariably requires continuous medical treatment. Advances in medical therapy over the last decades and current developments offer increasing options and are closely associated with a better life quality in patients.. Recent developments in understanding the pathogenesis of UC are discussed. The current standard therapeutic regimens are outlined and recent developments and upcoming strategies introduced.. (1) Environmental factors that are yet to be defined contribute to the pathogenesis of UC. (2) An accelerated step-up therapy represents the current standard in UC. (3) Anti-integrins represent the most recently introduced pharmacological class in the therapy of UC. (4) Novel strategies including Janus kinase inhibitors are in the near future.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal, Humanized; Biosimilar Pharmaceuticals; Colitis, Ulcerative; Gastrointestinal Agents; Glucocorticoids; Humans; Immunosuppressive Agents; Infliximab; Integrins; Janus Kinases; Mercaptopurine; Mesalamine; Piperidines; Pyrimidines; Pyrroles; Remission Induction; Tumor Necrosis Factor-alpha

The management of patients with ulcerative colitis who are dependent on corticosteroid for control of symptoms, or refractory to corticosteroids or standard immunosuppressive therapy, is challenging. The development of newer medical therapies has increased the options for managing patients in this situation, but access and funding remain limited. This guideline summarises the literature regarding this situation and provides guidance as to the management of refractory colitis in the New Zealand setting.

Topics: Adalimumab; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Appendectomy; Azathioprine; Colitis, Ulcerative; Cyclosporine; Drug Resistance; Drug Therapy, Combination; Fecal Microbiota Transplantation; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Infliximab; Leukapheresis; Mercaptopurine; Mesalamine; Methotrexate; New Zealand; Pediatrics; Piperidines; Proctocolectomy, Restorative; Protein Kinase Inhibitors; Pyrimidines; Pyrroles; Recurrence; Severity of Illness Index; Tacrolimus; Tumor Necrosis Factor-alpha