| Theme |
Up-to-date Treatment for Inflammatory Bowel Diseases |
| Title |
Therapeutic Indications and Effects of Immuno-modulators for Ulcerative Colitis |
| Author |
Tomoyuki Tsujikawa |
Department of Internal Medicine, Shiga Unirersity of Medical Science |
| Author |
Yoshihide Fujiyama |
Department of Internal Medicine, Shiga Unirersity of Medical Science |
| [ Summary ] |
The immuno-modulator AZA / 6-MP is used to taper off steroids in steroid dependent UC cases or for maintenance during remission. AZA / 6-MP is metabolized to 6-TG by the enzyme TPMT and others. 6-TG (normal range ; 235 - 450 pmol / 8 x 108 RBC) acts on lymphocytes. A daily dose of AZA at 50 mg or 6-MP at 30 mg is recommended. Some patients readily experience adverse effects because of TPMT's genetic polymorphism. Although 2 - 3 months are required for drug acvitity to be to expressed, period blood examinations are necessary to avoid early adverse effects such as bone marrow suppression and liver dysfunction. Concerning the increased risk of malignancy after longterm administration of AZA / 6-MP, there was no statistical difference seen in meta-analysis. However, further consideration is required of the possibility of malignant lymphoma linked to anti TNF-α antibodies. |