Clinical Symposium on the Inflammatory Bowel Disease on the Doctor in Focus location:Montreux, Switzerland date:4-5- Feb 2000
Corticosteroids, 5-aminosalicylic acid (5-ASA) and antibiotics are traditional treatments for flare-ups of Crohn's disease and are useful in their immediate treatment but show few or no long-term responses. For management of steroid-dependent patients or those with refractory disease, the immunosuppressants azathioprine, 6-mercaptopurine, methotrexate and cyclosporin help to maintain remission. However, some patients stop responding to these drugs and concerns over toxicity and neoplasia limit their use. This has led to the development of novel approaches such as immunomodulation therapy using cytokines and anticytokines. The proinflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) plays a leading role in mucosal inflammation. TNF inhibition can be achieved with pentoxyfylline and thalidomide and also through the inactivation of TNF-alpha convertase (TACE). The antiTNF monoclonal immunoglobulin G1 (IgG1) antibody infliximab can thoroughly inactivate both cellular and free mucosal TNF and has been shown to be an effective therapy for refractory Crohn's disease. Other novel approaches include anti-IL-12, anti-interferon-gamma, antisense oligonucleotides to intercellular adhesion molecule-1 and NF kappaB, as well as the administration of the immunoregulatory cytokines IL-10 and IL-11. (C) 2000 Prous Science. All rights reserved.