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Nonbiologic Therapy for Autoimmune Diseases



Clinical expertise on the use of corticosteroids and mesalamine-based products in the management of autoimmune diseases.

Transcript

Marla Dubinsky, MD: When we talk about treatments for IBD [inflammatory bowel disease], I think we group them into “biologic” or “not.” I’ll start with the “not,” because it’s a little easier. The “not” group would include corticosteroids, which are somewhat of the mainstay of IBD treatment, particularly ulcerative colitis, given the urgency of getting those symptoms under control. Corticosteroids work quickly. About 85% of patients respond quite nicely to steroids. If you’re hospitalized, intravenous steroids are the only thing that can control the symptoms when someone’s going to the restroom every half hour or are up all night because they’re having constant spasm of their rectum giving them urgency. We must get something going quickly. Not all our treatments work as quickly as steroids. Within 24 to 48 hours, patients are feeling a lot better.

There are a lot of adverse effects, and steroids are only a short-term solution. There always needs to be an exit strategy when you start steroids. Immediately, you need to think about a companion treatment as a steroid-sparing strategy.

I’ve used steroids as inflammatory treatment. They don’t go after the biology of the disease. They just sort of Band-Aid the inflammation. Another Band-Aid of inflammation would be to use a mesalamine-based product. There are multiple mesalamine-based products out there. All of them sort of open up in the intestinal tract. Depending on whether it’s pH release or time-dependent release or colon-only release, or the way it travels to the colon, the bottom line is that they provide, again, a local, almost topical anti-inflammatory effect.

There are no mesalamine-based products approved for Crohn. However, for some strange reason, mesalamines are still used for Crohn disease, often as first-line therapy. This is unacceptable unless you have very mild, very local inflammation in a patient with Crohn—like what we call no deep ulcerations or no breaks in the mucosa. This occurs in 10% to 15% of patients. Most patients with Crohn have ulcers that penetrate beyond the mucosa. So to use a drug that works only on the mucosa is counterintuitive. That’s why there’s no mesalamine-based product approved for Crohn. Many are approved for ulcerative colitis. That makes sense because ulcerative colitis is a mucosal disease. We can all wrap our head around mesalamines in ulcerative colitis. However, for mesalamine-based products in Crohn, there’s no rule. In the vein of steroids, there are also topical steroids that, again, using pH release, release specifically in the end of the ileum.



Episode #1

Pathophysiology of Autoimmune Diseases and Inflammation
Pathophysiology of Autoimmune Diseases and Inflammation

Episode #2

Distinguishing Between Autoimmune Conditions: IBD
Distinguishing Between Autoimmune Conditions: IBD

Episode #3

Factors and Exposures Linked to Autoimmune Diseases
Factors and Exposures Linked to Autoimmune Diseases

Episode #4

Accurately Diagnosing an Autoimmune Disease
Accurately Diagnosing an Autoimmune Disease

Episode #5

Nonbiologic Therapy for Autoimmune Diseases
Nonbiologic Therapy for Autoimmune Diseases

Episode #6

Steroid-Sparing Therapies for Autoimmune Disease
Steroid-Sparing Therapies for Autoimmune Disease

Episode #7

Biologics and Small Molecules for Autoimmune Diseases
Biologics and Small Molecules for Autoimmune Diseases

Episode #8

TNF Inhibitors: Patient Selection
TNF Inhibitors: Patient Selection

Episode #9

Relationship Between Pregnancy and Autoimmune Disease
Relationship Between Pregnancy and Autoimmune Disease

Episode #10

Biologic Therapies and Pregnancy: Inflammation Control
Biologic Therapies and Pregnancy: Inflammation Control

Episode #11

Discontinuing/Switching of Biologics During Pregnancy
Discontinuing/Switching of Biologics During Pregnancy

Episode #12

Counseling Patients on Inflammation Control and Pregnancy
Counseling Patients on Inflammation Control and Pregnancy

Episode #13

Advances in Inflammation Control Throughout Pregnancy
Advances in Inflammation Control Throughout Pregnancy

Episode #14

A Clinical Background on Autoimmune Disease
A Clinical Background on Autoimmune Disease

Episode #15

Treatment Considerations and Autoimmune Disease
Treatment Considerations and Autoimmune Disease

Episode #16

TNF Inhibitors and Autoimmune Disease
TNF Inhibitors and Autoimmune Disease

Episode #17

Pregnancy and Autoimmune Disease
Pregnancy and Autoimmune Disease

Episode #18

Treatment Considerations for Childbearing and Autoimmune Disease
Treatment Considerations for Childbearing and Autoimmune Disease

Episode #19

Managing Autoimmune Disease Post Partum
Managing Autoimmune Disease Post Partum
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