Review Article: Monitoring of Immunomodulators in Inflammatory Bowel Disease

F. N. Aberra; G. R. Lichtenstein


Aliment Pharmacol Ther. 2005;21(4):307-319. 

In This Article

Summary and Introduction

The armamentarium of medications for the treatment of inflammatory bowel disease is growing and becoming more complicated to use. Immunomodulators are a class of medications that have found a niche for the treatment of Crohn's disease and ulcerative colitis. Because of the mounting supporting evidence for efficacy, the most commonly-used immunomodulators are azathioprine, mercaptopurine, methotrexate and ciclosporin. These medications are being used more often due to their steroid-sparing and potentially surgery-sparing effects. Immunomodulators are also known for a significant side-effect profile and require careful monitoring. This review provides the latest information for clinicians on efficacy, side-effects, dosing and monitoring of these medications for treatment of inflammatory bowel disease.

Treatment of inflammatory bowel diseases (IBD) commonly requires utilization of immunodulatory medications. This class of medications includes azathioprine (AZA), mercaptopurine (MP), ciclosporin, methotrexate, and on occasion mycophenolate mofetil and tacrolimus. The most commonly used immunomodulators for treatment of IBD are AZA, MP, ciclosporin and methotrexate. These medications have shown to be effective and great care must be taken in monitoring patients receiving these medications to maximize clinical benefit and reduce the risk of side-effects and toxicity. This review will provide information on clinical pharmacology, clinical indications for use, methods of dose adjusting, monitoring of metabolites for efficacy and for potential side-effects, and the adverse event profile for each medication. This review will hopefully provide guidance on utilizing immunomodulators for Crohn's disease (CD) and ulcerative colitis (UC) based on the published literature.


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