Abstract:
:Thiopurine analogs and anti-tumor necrosis factor (TNF) agents have dramatically changed the therapeutics of inflammatory bowel diseases (IBD), improving short and long-term outcomes. Unfortunately some patients do not respond to therapy and others lose response over time. The pharmacokinetic properties of these drugs are complex, with high inter-patient variability. Thiopurine analogs are metabolized through a series of pathways, which vary according to the patients' pharmacogenetic profile. This profile largely determines the ratios of metabolites, which are in turn associated with likelihoods of clinical efficacy and/or toxicity. Understanding these mechanisms allows for manipulation of drug dose, aiming to reduce the development of toxicity while improving the efficacy of treatment. The efficacy of anti-TNF drugs is influenced by many pharmacodynamic variables. Several factors may alter drug clearance, including the concomitant use of immunomodulators (thiopurine analogs and methotrexate), systemic inflammation, the presence of anti-drug antibodies, and body mass. The treatment of IBD has evolved with the understanding of the pharmacologic profiles of immunomodulating and TNF-inhibiting medications, with good evidence for improvement in patient outcomes observed when measuring metabolic pathway indices. The role of routine measurement of metabolite/drug levels and antibodies warrants further prospective studies as we enter the era of personalized IBD care.
journal_name
World J Gastroenteroljournal_title
World journal of gastroenterologyauthors
Yarur AJ,Abreu MT,Deshpande AR,Kerman DH,Sussman DAdoi
10.3748/wjg.v20.i13.3475subject
Has Abstractpub_date
2014-04-07 00:00:00pages
3475-84issue
13eissn
1007-9327issn
2219-2840journal_volume
20pub_type
杂志文章,评审abstract:AIM:To evaluate the diagnostic efficiency of endoscopic ultrasound (EUS) as the main imaging modality in patients with moderate suspicion of common bile duct stones (CBDS). METHODS:55 patients with moderate clinical suspicion of CBDS were prospectively included to the study and evaluated with EUS. This study was done ...
journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v9.i3.612
更新日期:2003-03-01 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v10.i18.2690
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abstract::Neurofibromas of the large bowel are very rare and usually are part of the colonic involvement in neurofibromatosis type 1 (Nf1, von Recklinghausen's disease). Solitary neurofibromas of the colon are extremely rare. We describe a case of an isolated neurofibroma that was found in the large bowel of a patient who suffe...
journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
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更新日期:2005-09-21 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 社论
doi:10.3748/wjg.15.2433
更新日期:2009-05-28 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v11.i19.2927
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v10.i15.2223
更新日期:2004-08-01 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
doi:10.3748/wjg.v23.i17.3030
更新日期:2017-05-07 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
doi:10.3748/wjg.v20.i16.4574
更新日期:2014-04-28 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,多中心研究
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
doi:10.3748/wjg.v22.i4.1532
更新日期:2016-01-28 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v13.i27.3756
更新日期:2007-07-21 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v12.i28.4492
更新日期:2006-07-28 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v22.i18.4604
更新日期:2016-05-14 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
doi:10.3748/wjg.v13.i17.2461
更新日期:2007-05-07 00:00:00
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pub_type: 杂志文章
doi:10.3748/wjg.v9.i1.50
更新日期:2003-01-01 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
doi:10.3748/wjg.v22.i7.2284
更新日期:2016-02-21 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v19.i45.8449
更新日期:2013-12-07 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v24.i34.3861
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pub_type: 杂志文章
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v19.i39.6689
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v17.i6.708
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v20.i34.12341
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pub_type: 杂志文章
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
doi:10.3748/wjg.14.3974
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journal_title:World journal of gastroenterology
pub_type: 信件
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v12.i37.6008
更新日期:2006-10-07 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.14.1293
更新日期:2008-02-28 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.14.2010
更新日期:2008-04-07 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2015-06-21 00:00:00