Celiac disease medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
A minority of patients suffer from refractory disease, which means that they do not improve with a [[gluten-free diet]]. Pharmocotherapy is used if alternative causes are eliminated and dietary modification is not beneficial. Pharmacotherapy include [[Steroid|steroids]], [[azathioprine]], [[Cyclosporine|cyclosporin]], and [[monoclonal antibodies]]. | Preferred therapy for celiac disease is dietary modification which includes [[gluten-free diet]]. Patients with celiac disease should be referred to a [[dietitian]] once the diagnosis of celiac disease is made. A minority of patients suffer from refractory disease, which means that they do not improve with a [[gluten-free diet]]. Pharmocotherapy is used if alternative causes are eliminated and dietary modification is not beneficial. Pharmacotherapy include [[Steroid|steroids]], [[azathioprine]], [[Cyclosporine|cyclosporin]], and [[monoclonal antibodies]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Refractory disease=== | ===Refractory disease=== | ||
A minority of patients suffer from refractory disease, which means they do not improve | A minority of celiac disease patients suffer from refractory disease, which means that they do not improve with 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 are inadvertently contaminated with [[gluten]]. Pharmocotherapy is used if alternative cause is elimiated.<ref name="pmid20332526">{{cite journal |vauthors=Rubio-Tapia A, Murray JA |title=Classification and management of refractory coeliac disease |journal=Gut |volume=59 |issue=4 |pages=547–57 |year=2010 |pmid=20332526 |pmc=2861306 |doi=10.1136/gut.2009.195131 |url=}}</ref> | ||
* 1 | * 1 '''Steroids''' | ||
:::* Preferred regimen(1): [[Prednisone]] 0.5–1 mg/kg q24h | :::* Preferred regimen(1): [[Prednisone]] 0.5–1 mg/kg q24h | ||
:::* Preferred regimen(2): [[Budesonide]] 9 mg 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 | :::* Preferred regimen(3): [[Prednisone]] 0.5–1 mg/kg q24h and [[azathioprine]] 2 mg/kg q24h combination | ||
* 2 | * 2 '''Immunosupressive drugs''' (Used in [[Steroid|steroid-dependent]] or [[Steroid|steroid-refractory]] disease) | ||
** 2.1 '''Antiproliferative agents''' | ** 2.1 '''Antiproliferative agents''' | ||
:::* Preferred regimen(1): [[Azathioprine]] 2 mg/kg q24h | |||
** 2.2 '''Calcineurin Inhibitors:''' | ** 2.2 '''Calcineurin Inhibitors:''' | ||
:::* Preferred regimen(1): [[Cyclosporine]] 5 mg/kg q24h PO | |||
** 2.3 '''Monoclonal antibodies''' | ** 2.3 '''Monoclonal antibodies''' | ||
:::* Preferred regimen(1): [[Infliximab]] 5 mg/kg q24h | |||
:::* Preferred regimen(2): [[Alemtuzumab]] 30 mg twice a week for 12 weeks | |||
==References== | ==References== | ||
Revision as of 15:29, 13 September 2017
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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
Preferred therapy for celiac disease is dietary modification which includes gluten-free diet. Patients with celiac disease should be referred to a dietitian once the diagnosis of celiac disease is made. A minority of patients suffer from refractory disease, which means that they do not improve with a gluten-free diet. Pharmocotherapy is used if alternative causes are eliminated and dietary modification is not beneficial. Pharmacotherapy include steroids, azathioprine, cyclosporin, and monoclonal antibodies.
Medical Therapy
Refractory disease
A minority of celiac disease patients suffer from refractory disease, which means that they do not improve with 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 are inadvertently contaminated with gluten. Pharmocotherapy is used if alternative cause is elimiated.[1]
- 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 Immunosupressive 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 for 12 weeks
References
- ↑ Rubio-Tapia A, Murray JA (2010). "Classification and management of refractory coeliac disease". Gut. 59 (4): 547–57. doi:10.1136/gut.2009.195131. PMC 2861306. PMID 20332526.