Immunomodulators (immunosuppressants) for Crohn's disease and ulcerative colitis

What are immunomodulators?

Immunomodulators - often referred to as immunosuppressants - are a type of medication which weaken or modulate the activity of the immune system. In inflammatory bowel disease (IBD) this decreases the inflammatory response the body has which is thought to play a role in IBD flares. They have been used since the 1960s to treat Crohn’s disease and ulcerative colitis.

Types of immunomodulators include:

Azathioprine and 6-Mercaptopurine can take between 3-6 months to work so may be combined with another medication, such as corticosteroids, initially.

Who can take immunomodulators?

In generally immunosuppressant medications are used in people with moderate to severe Crohn’s disease or ulcerative colitis and have not responded well to aminosalicylates or corticosteroids, or to help if someone is steroid-dependent or needs them frequently. They are also used in people with perianal disease that does not respond to other treatment or people with fistulas.

How are immunomodulators taken?

Azathioprine and 6-Mercaptopurine - which are both chemically quite similar - are taken orally on a daily basis. Cyclosporine A and tacrolimus are also taken orally, though tacrolimus can also be applied topically in the case of oral or perianal IBD.

Methotrexate is taken via injection - often weekly - which can be done at home.

What side effects are there of immunomodulators?

Reported side effects of azathioprine and 6-MP include:

Reported side effects of cyclosporine and tacrolimus include:

Reported side effects of methotrexate include:

What else do I need to know about immunosuppressants?

As immunomodulators suppress the immune system you may be susceptible to catching infections more easily. They can also have an effect on bone marrow, liver and kidneys, therefore you may be required to have regular blood tests to check these.

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