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

Updated: Apr 10, 2020
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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Immunosuppressant agents are useful as steroid-sparing agents, in healing fistulas, and in patients with serious contraindications to surgery. [109] These drugs are used in patients who are refractory to or unable to tolerate steroids and in patients in whom remission is difficult to maintain with the aminosalicylates alone. Azathioprine and its metabolite, 6-mercaptopurine (MP), are useful in Crohn disease complicated by recurrent rectal fistulas or perianal disease; however, the clinical response can take up to 6 months. Methotrexate has also been tried.

Azathioprine (Imuran, Azasan)

Azathioprine inhibits mitosis and cellular metabolism by antagonizing purine metabolism and inhibiting synthesis of DNA, RNA, and proteins; these effects may decrease the proliferation of immune cells and result in lower autoimmune activity.

6-Mercaptopurine (Purinethol, Purixan)

6-Mercaptopurine is a purine analog that inhibits DNA and RNA synthesis, causing arrest of cell proliferation.

Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo)

Methotrexate impairs DNA synthesis and induces the apoptosis and reduction in interleukin (IL)-1 production. It is indicated for moderate to severe disease and maintenance of remission. The onset of action is delayed.

Cyclosporine (Sandimmune, Neoral, Gengraf)

According to the American Gastroenterological Association (AGA) guidelines, intravenous cyclosporine is effective for avoiding surgery in patients with ulcerative colitis who have failed to respond to 7-10 days of high-dose oral or parenteral corticosteroids. Concomitant administration of IV corticosteroids is recommended in these cases.

Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions, such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft-versus-host disease.

For children and adults, dosing is based on ideal body weight.

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