Which medications in the drug class Immunosuppressants are used in the treatment of Crohn Disease?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Immunosuppressant agents are used off label to treat moderate-to-severe Crohn disease, to treat steroid-dependent or steroid-refractory disease, and to maintain remission.

Mercaptopurine (Purinethol)

6-MP and its prodrug azathioprine are purine analogues; they interfere with protein synthesis and nucleic acid metabolism and have cytotoxic effect on lymphoid cells. If steroid withdrawal proves difficult, immunosuppressants such as 6-MP may be considered.

Azathioprine (Imuran, Azasan)

Azathioprine antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. It may decrease proliferation of immune cells, which lowers autoimmune activity.

Methotrexate (Trexall, Rheumatrex)

Methotrexate is used for the treatment of moderate-to-severe Crohn disease and maintenance of remission. It is effective in inducing and maintaining remission in chronic Crohn disease in adults and has been shown to be effective and well tolerated for maintenance of remission in children. Methotrexate is a structural analogue of folic acid that inhibits binding of dihydrofolic acid to the enzyme dihydrofolate reductase. It impairs DNA synthesis, induces apoptosis, and reduces interleukin (IL)-1 production.

Tacrolimus (Prograf, Hecoria)

Tacrolimus is an immunomodulator produced by the bacteria Streptomyces tsukubaensis. Its mechanism of action is similar to that of cyclosporine. Tacrolimus may be effective in treating Crohn disease.

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