Celiac disease medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

A minority of patients suffer from refractory disease, which means that they do not improve with a gluten-free diet. Pharmacotherapy is used if dietary modification is not beneficial. Pharmacotherapy include steroids, azathioprine, cyclosporine, and monoclonal antibodies.

Medical Therapy

Refractory disease

A minority of patients suffer from refractory disease, which means they do not improve on a gluten-free diet. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone or the patient is not adhering to the diet, or the patient is consuming foods that contain gluten. Pharmacotherapy is used if dietary modification is not effective.

• 1. Steroids

• Preferred regimen(1): Prednisone 0.5–1 mg/kg q24h
• Preferred regimen(2): Budesonide 9 mg q24h
• Preferred regimen(3): Prednisone 0.5–1 mg/kg q24h and azathioprine 2 mg/kg q24h combination

• 2. Immunosuppressive drugs (Used in steroid dependent or steroid refractory disease)
  • 2.1 Antiproliferative agents
    • Preferred regimen(1): Azathioprine 2 mg/kg q24h
  • 2.2 Calcineurin Inhibitors:
    • Preferred regimen(1): Cyclosporine 5 mg/kg q24h PO
  • 2.3 Monoclonal antibodies
    • Preferred regimen(1): Infliximab 5 mg/kg q24h
    • Preferred regimen(2): Alemtuzumab 30 mg twice a week per 12 weeks

Dermatitis herpetiformis

• 1. Life style modification
  • 1.1 Gluten-free diet (GFD)
• 2. Pharmocatherapy
  • 2.1 Sulfones
    • Preferred treatment(1): Dapsone 50 mg q24h increased every week until clearance or tolerance
  • 2.2 Suhphonamides
    • Alternative treatment (1): Sulfasalazine 500 mg q8h (maximum, 2g q8h)
  • 2.3 Combination treatment
    • Alternative treatment (1): Dapsone plus sulfasalazine
  • 2.4 Other treatment (intolerance or allergies to dapsone and sulfasalazine)
    • Alternative treatment (1): Colchicine
    • Alternative treatment (2): Cholestyramine
    • Alternative treatment (3): Tetracycline
    • Alternative treatment (4): Niacinamide
    • Alternative treatment (5): Heparin
    • Alternative treatment (6): Cyclosporin
  • 2.5 Monoclonal antibodies
    • Preferred treatment(1): Rituximab

    Note: Used is severe cases not improved by other medications.