From: Crohn’s disease in a developing African mission hospital: a case report
Group | Drugs | Routes | Efficacy | Recommended testing | Adverse drug reactions |
---|---|---|---|---|---|
5-Aminosalycilates | Mesalamine Balsalazide Sulfasalazine | Oral Rectal | Induction and maintenance | Cr, urinalysis CBC, LFTs | Headache, nausea, diarrhea Paradoxical worsening of symptoms Interstitial nephritis Hemolytic anemia,a leukopenia,a hepatitisa |
Corticosteroids | Prednisone Budesonide Methylprednisolone | Oral Rectal IV | Induction only | Consider checking hemoglobin A1c and vitamin D levels If prolonged steroid > 3 mo: DEXA scan and ophthalmologic evaluation | Osteopenia/osteoporosis Avascular necrosis Serious infection Weight gain Insomnia Mood changes Delirium Cataracts Glaucoma Skin changes Delayed wound healing Adrenal insufficiency |
Thiopurines | Azathioprine Mercaptopurine | Oral | Maintenance | TPMT enzyme activity or genetics before initiation CBC, LFTs Skin examinations Yearly Pap smear in women | Nausea Vomiting Transaminitis Bone marrow suppression Pancreatitis Infection Non-Hodgkin lymphoma Nonmelanoma skin cancer Cervical dysplasia |
Methotrexateb | Methotrexate | SC or IM (limited efficacy of oral route) | Induction and maintenance | CBC, LFTs | Infection Cytopenias Transaminitis Cirrhosis Nausea/vomiting Flulike symptoms Oral ulcers Pulmonary toxicity Contraindicated in pregnancy |
Anti-TNF | Infliximab Adalimumab Certolizumab pegol | IV SC | Induction and maintenance | Latent TB and hepatitis B before initiation CBC, LFTs Skin examinations | Infusion/injection site reaction Infection Non-Hodgkin lymphoma (mostly if combined with a thiopurine) HSTC-L (if combined with a thiopurine) Melanoma Reactivation of latent TB and hepatitis B Drug-induced lupus erythematosus Demyelinating disease Psoriasiform and eczema reactions Worsening of CHF |
Adhesion molecule inhibitors | Natalizumab Vedolizumab | IV | Induction and maintenance | Natalizumab: JC virus checking before initiation and yearly monitoring for JC virus Vedolizumab and natalizumab: Consider CBC | Infusion reactions Infection Nasopharyngeal polyps PML (natalizumab only with positive JC virus |
IL-12/IL-23 inhibitors | Ustekinumab | IV SC | Induction and maintenance | Latent TB before initiation Consider CBC, LFTs | Infusion reactions Skin cancer Reversible posterior leukoencephalopathy TB |