Leflunomide Treatment of Crohn's Disease Patients Intolerant to Standard Immunomodulator Therapy

  title={Leflunomide Treatment of Crohn's Disease Patients Intolerant to Standard Immunomodulator Therapy},
  author={Devang N. Prajapati and Joshua F. Knox and Jeanne Emmons and Kia Saeian and Mary Ellen Csuka and David G Binion},
  journal={Journal of Clinical Gastroenterology},
Background Immunomodulator therapy with the purine analogs azathioprine and 6-mercaptopurine (6-MP), is efficacious in the treatment of moderate to severe Crohn's disease (CD), but is not tolerated by a significant minority of patients. The pyrimidine analog, leflunomide, has demonstrated efficacy in the treatment of rheumatoid arthritis (RA) patients. Because established RA immunomodulator agents may demonstrate success in the treatment of CD, we reviewed our clinical open-label experience… 

Treatment of Crohn’s Disease with Leflunomide as Second-Line Immunosuppression

Leflunomide may improve disease activity, especially in terms of arthralgias, and reduce steroid intake, and reduces steroid intake in patients with Crohn's disease refractory or intolerant to azathioprine.

Leflunomide: long-term clinical experience and new uses

Economic studies indicate that leflunomide is a cost-effective option in the treatment of RA, and new investigations with leflinomide have focused mainly on combination regimens for the Treatment of RA and the use of leflanomide in other inflammatory or autoimmune disorders.

Recent developments in the pharmacological treatment of Crohn’s disease

Several other promising therapies, such as cyclophosphamide, extracorporeal photochemotherapy, stem cell transplantation and the use of porcine whipworm, add to the available therapeutic armamentarium of this life-long remitting and relapsing disease.

Leflunomide: a novel disease modifying anti-rheumatic drug.

Leflunomide (active metabolite A77 1726) is one such new drug with novel immunomodulatory and anti-inflammatory properties that has shown promising results in terms of efficacy and safety for the treatment of this crippling autoimmune disease and is a welcome addition to the roster of anti-rheumatoid drugs.

Medical management of Crohn's disease: current therapy and recent advances

Information from randomized controlled trials involving the immunomodulators azathioprine, 6-mercaptopurine and methotrexate have been accumulated, advancing knowledge on how to best to use these agents for the induction and maintenance of remission in patients with Crohn's disease.

Newer therapies for inflammatory bowel disease

Therapies utilizing novel mechanistic approaches, such as hematopoietic growth factors, mitogen-activated protein (MAP)-kinase inhibition, and peroxisome proliferator activated receptor gamma ligand receptor binding have shown promise in small uncontrolled trials and await confirmation of their utility in randomized, placebo-controlled trials.

Novel Therapies for Crohn's Disease: Focus on Immunomodulators and Antibiotics

A number of new treatment modalities are being investigated for Crohn's disease, many of them are promising, and some of these agents may be considered in treatment-refractory patients in the future.

Advances in medical therapy of inflammatory bowel disease.

Medical therapy of Crohn disease

There appears to be an expanding array of treatment options that will become available to clinicians for the treatment of Crohn disease and as the treatment options expand, questions regarding optimal combination treatment strategies will need to be answered.

Increased Rates of Early Adverse Reaction to Azathioprine in Patients with Crohn's Disease Compared to Autoimmune Hepatitis: A Tertiary Referral Center Experience

CD patients represent a unique subgroup at increased risk of EAR to azathioprine, and Mechanisms behind these reactions need to be further defined.



Is mycophenolate mofetil an effective alternative in azathioprine-intolerant patients with chronic active Crohn's disease?

It seems that AZA still is the immunouppressant of choice in chronic active CD, but MMF is a reasonable alternative in patients who do not tolerate AZA.

The efficacy of azathioprine for the treatment of inflammatory bowel disease: a 30 year review

The efficacy of azathioprine is reasonably well sustained over five years and there was no difference in relapse rates between Crohn's disease and ulcerative colitis.

An Open-Label Pilot Study Using Thioguanine as a Therapeutic Alternative in Crohn's Disease Patients Resistant to 6-Mercaptopurine Therapy

6-TG was a safer and more efficacious thiopurine in this subgroup of IBD patients resistant to 6-MP therapy, and larger controlled trials are warranted to further evaluate both the short- and long-term safety and efficacy.

Leflunomide and malononitrilamides.

A controlled double blind study of azathioprine in the management of Crohn's disease.

In conclusion, azathioprine offers a therapeutic advantage over placebo in the maintenance of remission in Crohn's disease.

Infliximab retreatment in adults and children with Crohn's disease: risk factors for the development of delayed severe systemic reaction

Episodic infliximab retreatment—specifically, a distant second infusion—is associated with high rates of severe systemic reaction in adults, but not children.

A comparison of methotrexate with placebo for the maintenance of remission in Crohn's disease

A selection of letters from the archives of the British Library, edited by M.B RIAN G.D.