Treatment of inflammatory bowel disease

2,407 views

Published on

FOR MORE MEDICAL PRESENTATIONS AND VIDEOS

Published in: Health & Medicine
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,407
On SlideShare
0
From Embeds
0
Number of Embeds
82
Actions
Shares
0
Downloads
96
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Treatment of inflammatory bowel disease

  1. 1.  Antimetabolite Benificial in number of c/c inflammatory d/s including crohns d/s, rheumatoid arthritis & in cancer Given orally, subcutaneously or I/M
  2. 2. DHFA Dihydro folate reductase THFA  This step is important in production of thymidine and purine
  3. 3.  High doses, used in chemotherapy, inhibits cellular proliferation. Low dose is used in treatment of IBD(12-25mg/wk). Interfere with inflammatory actions of interleukin-1. Stimulate increased release of adenosine, an endogenous anti-inflammatory autocoid. Also stimulate apoptosis & death of activated T- lymphocytes
  4. 4.  Induce & maintain remission in patients with crohns d/s. Efficacy in ulcerative colitis is uncertain. To induce remission, 15-25mg given once weekly by subcutaneous inj. If satisfactory response in 8-12wks, dose is reduced to 15mg/wk
  5. 5.  At high doses, cause BONE MARROW DEPRESSION, MEGAIOBLASTIC ANAEMIA, ALOPACIA & MUCOSITIS Folate supplimentation reduces risk of events without impairing anti inflammatory effect.
  6. 6.  Dysregulation of TH1 response is present in IBD. Key proinflammatory cytokine in TH1 response is TNF-alpha. INFLIXIMAB is a chimeric mouse human monoclonal Ab to human TNF- alpha Given I/v, therapeutic dose 5-10mg/kg & plasma t1/2 is 8-10days
  7. 7.  TNF-alpha trimers bind to cell-surface TNF-alpha receptors. INFLIXIMAB bind to soluble TNF-alpha trimers with high affinity, preventing cytokine from binding to receptors. It also bind to membrane bound TNF- alpha & neutralises its activity. Also promote compliment activation & Ab-mediated apoptosis & cellular cytotoxicity of activated T- lymphocytes & macrophages.
  8. 8.  Used in a/c & c/c treatment of patients with moderate to severe Crohns d/s & Ulcerative colitis. INFLIXIMAB induction therapy – dose 5mg/kg at 0, 2, &6wks. In patients who respond can be treated with repeat infusions every 8wks. Other anti-TNF agent approved are ADALIMUMAB & CERTOLIZUMAB.
  9. 9.  Infection due to suppresion of TH1 inflammatory response. Reactivation of latent TB, with dissemination. Other infections include pneumonia, sepsis, pneumosistosis, histoplasmosis, listeriosis & reactivation of hepatits B. May cause severe hepatic reactions leading to a/c hepatic failure. May worsen CHF in cardiac disease.
  10. 10. o INTEGRINS are adhesion molecules on surface of leucocytes that interact with another class of adhesion molecules on the surface of vascular endothelium known as SELECTIN, allowing circulating leucocytes to adhere & subsequently move through the vessel wall into the tissue.o Integrins contain two subunits alpha & beta.o NATALIZUMAB a humanized IgG4 monoclonal Ab targeted against alpha-2 subunit.
  11. 11.  Used in patients with moderate to severe Crohns disease. DOSE-300mg every 4 wks by I/V infusion & patient should not be on any immunosuppressive treatment. ADVERSE EFFECTS- a/c infusion reactions & small risk of oppurtunistic infections.

×