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  • Review Article
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Optimization of conventional therapy in patients with IBD

Nature Reviews Gastroenterology & Hepatology volume 8, pages 646–656 (2011)Cite this article

Subjects

Abstract

The majority of patients with IBD use conventional therapy (namely, aminosalicylates, antibiotics, corticosteroids and immunomodulatory agents) for prolonged periods of time, to both induce and maintain remission. Treatment paradigms in IBD have evolved towards a rapid escalation of therapy to achieve stringent goals, including mucosal healing and a reduction in the need for hospital admission and surgery. In this context, the failure to optimize conventional therapy can lead to a potentially effective treatment being abandoned too early, which is undesirable when only a limited number of drugs are effective in the management of IBD, and could also lead to patients being unnecessarily exposed to potentially toxic and/or expensive biologic drugs. This Review provides an overview of the many ways in which conventional therapy can be optimized, and describes strategies to improve adherence to drug regimens, such as simplifying the dosing regimen, optimizing drug delivery and dose, and tailoring medication on the basis of metabolite levels.

Key Points

  • Treating physicians should enquire about and encourage patients' adherence to drug dosage schedules

  • Measures that improve adherence, such as changing to once-daily dosing, should be considered

  • Doses should be maximized in patients who fail to achieve remission or during disease flares

  • Metabolite monitoring can be used to help identify reasons for a lack of response or intolerance to thiopurines; the patient's treatment should then be tailored as appropriate

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Figure 1: Strategies to consider for optimization of 5-aminosalicylate therapy.
Figure 2: Enema distribution for each colonic region in patients with active ulcerative colitis.
Figure 3: Metabolism of azathioprine.

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  1. Department of Gastroenterology, Guy's & St Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK

    Kirstin M. Taylor & Peter M. Irving

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  1. Kirstin M. Taylor
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K. Taylor researched the data for the article. K.Taylor and P. M. Irving contributed equally to writing the article, discussions of its content, and to reviewing and/or editing the manuscript before submission.

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Correspondence to Peter M. Irving.

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Competing interests

K. M. Taylor declares no competing interests. P. M. Irving declares that he has acted as a consultant for Shire, and is a member of the speakers' bureaus or has received honoraria from Ferring Pharmaceuticals, Shire, and Warner Chilcott.

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Taylor, K., Irving, P. Optimization of conventional therapy in patients with IBD. Nat Rev Gastroenterol Hepatol 8, 646–656 (2011). https://doi.org/10.1038/nrgastro.2011.172

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