Immunosuppressants for the treatment of Crohn’s disease | Immunosuppressive drugs

Immunosuppressants for the treatment of Crohn’s disease

Crohn’s disease is a chronic inflammatory disease that can affect the entire gastrointestinal tract. The following immunosuppressive drugs are used to treat an acute attack: Budesonide, mesalazine and possibly prednisolone. Budesonide is a glucocorticoid that is metabolised to a large extent in the liver.

It therefore has mainly a regional effect in the gastrointestinal tract and few systemic side effects. Mesalazine belongs to the group of aminosalicylates and can be used as an alternative.It has an anti-inflammatory and immunosuppressive effect in the intestine. Prednisolone, a strong glucocorticoid, is used for severe relapses.

In contrast to budesonide, it is systemically active and therefore causes more side effects. If the relapse does not respond to this, biologicals, in this case Infliximab (TNF-alpha antibodies), are used to slow down the inflammation. In order to control the disease activity also between the attacks, the immunosuppressive drugs azathioprine as first choice or methotrexate as second choice are used as a long-term therapy. Therapy with Infliximab is also possible.

Immunosuppressive drugs for the treatment of rheumatism

Rheumatism, more precisely rheumatoid arthritis, can also be treated with immunosuppressive drugs. The cause of rheumatoid arthritis is an immune reaction in which the body attacks the joints by producing antibodies and activating macrophages (scavenger cells of the immune system), thereby causing inflammation in usually several joints. In rheumatic diseases, a distinction is also made between long-term and relapsing therapy.

Painkillers are used for relapse therapy and glucocorticoids are used as immunosuppressive agents. Glucocorticoids delay the destruction of the affected joints. The long-term therapy should be started as early as possible.

An important component and first choice is methotrexate, which must be taken once a week. It is often prescribed in combination with the anti-inflammatory glucocorticoids prednisone or prednisolone. In the course of therapy, it is often attempted to reduce the dose of glucocorticoids slightly so that the side effects of these drugs are less severe.

Recently, antibodies produced in the laboratory have also been used in rheumatism therapy. Methotrexate must not be taken at the same time as NSAIDs (ibuprofen, diclofenac, paracetamol, etc. ), as this will increase the side effects.

24-48h after taking MTX, folic acid is taken to reduce the side effects. The second choice is Leflunomid if MTX is not (sufficiently) effective. Sulfasalazine can be used during pregnancy in combination with folic acid. In severe cases, various biologicals (anti-TNF-alpha antibodies or interleukin-1 receptor antagonists) can be used.