Immunomodulatory therapy in paediatric inflammatory bowel disease

Abstract

Immunomodulatory drugs are indispensable in the treatment of children with both Crohn’s disease and ulcerative colitis, especially in maintaining remission. Among them, azathioprine and 6-mercaptopurine are the most effective in this respect and they elicit less adverse reactions compared to other immunomodulatory drugs. A very important benefit of immunomodulatory therapy is that they are steroid-sparing agents, which is especially essential in developing children. Although, due to their slow onset of action, most of these drugs are not appropriate for induction of remission, their early introduction may be helpful in faster tapering of steroids and bridging them to azathioprine or 6-mercaptopurine. In this review the mechanism of action, evidence based therapeutical efficiency and adverse reactions to immunomodulatory drugs will be reviewed.

Keywords

• inflammatory bowel disease
• immunoregulatory drugs
• thiopurines
• methotrexate
• calcineurin inhibitors