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Table 3 Medications, monitoring, and adverse events a [10]

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

  1. Abbreviations: Anti-TNF Anti-tumor necrosis factor, CBC Complete blood cell count, Cr Creatinine, CHF Congestive heart failure, DEXA Dual-energy X-ray absorptiometry, IV Intravenous, IM Intramuscular, SC Subcutaneous, JC John Cunningham, LFT Liver function test, FDA Food and Drug Administration, HSTLC Hepatosplenic T-cell lymphoma, PML Progressive multifocal leukoencephalopathy, Pap Papanicolaou, TB Tuberculosis, TPMT Thiopurine methyltransferase
  2. aSulfasalazine only
  3. bPatients should be given 1 g of folic acid with the medication to reduce side effects