What are the treatment options for refractory inflammatory bowel disease (IBD)?

Updated: Apr 10, 2020
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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If it is difficult to reduce the dose of corticosteroids, if the disease is refractory to corticosteroid therapy, or if patients are corticosteroid dependent, the use of immune modifiers 6-MP or azathioprine should be used. The typical dosing of 6-MP or azathioprine is 1-2 mg/kg/day. At higher doses, closer monitoring is warranted, including measurement of the thiopurine methyltransferase (TPMT) enzyme; obtaining 6-TG and 6-MMP levels; doing a CBC; and determining liver, kidney, pancreatic functions.

These agents are not used for acute flares, because the time from the initiation of treatment to the onset of significant action may be as long as 2-3 months. Response to immune modifiers may be dose dependent; monitoring of blood counts is required to protect the patient from the hematologic toxicity associated with these agents.

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