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]
- 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
- 2.1 Antiproliferative agents
Dermatitis herpetiformis
- 1. Life style modification[2]
- 1.1 Gluten-free diet (GFD)
- 2. Pharmocatherapy[3][4]
- 2.1 Sulfones
- Preferred treatment(1):Dapsone 50 mg q24h increased every week until clearance or tolerance
- 2.2 Suhphonamides
- Alternative treatment (1): Sulfapyridine 500 mg q8h (maximum, 2g q8h)
- 2.3 Combination treatment[5]
- Alternative treatment (1): Dapsone plus sulphsalazine
- 2.4 Other treatment (intolerance or allergies to dapsone and sulfapyridine)
- Alternative treatment (1): Colchicine[6]
- Alternative treatment (2): Cholestyramine
- Alternative treatment (3): Tetracycline[7]
- Alternative treatment (4): Niacinamide[7]
- Alternative treatment (5): Heparin[7]
- Alternative treatment (6): Cyclosporin
- 2.5 Monoclonal antibodies[8]
- Preferred treatment(1): Rituximab
- Note: Used is severe cases not improved by other medications.
- 2.1 Sulfones
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.
- ↑ Collin P, Reunala T (2003). "Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists". Am J Clin Dermatol. 4 (1): 13–20. PMID 12477369.
- ↑ Mutasim DF (2007). "Therapy of autoimmune bullous diseases". Ther Clin Risk Manag. 3 (1): 29–40. PMC 1936286. PMID 18360613.
- ↑ Han A (2009). "A practical approach to treating autoimmune bullous disorders with systemic medications". J Clin Aesthet Dermatol. 2 (5): 19–28. PMC 2924135. PMID 20729961.
- ↑ Bevans SL, Sami N (2017). "Dapsone and sulfasalazine combination therapy in dermatitis herpetiformis". Int. J. Dermatol. 56 (5): e90–e92. doi:10.1111/ijd.13542. PMID 28133723.
- ↑ Silvers DN, Juhlin EA, Berczeller PH, McSorley J (1980). "Treatment of dermatitis herpetiformis with colchicine". Arch Dermatol. 116 (12): 1373–84. PMID 7458365.
- ↑ 7.0 7.1 7.2 Shah SA, Ormerod AD (2000). "Dermatitis herpetiformis effectively treated with heparin, tetracycline and nicotinamide". Clin. Exp. Dermatol. 25 (3): 204–5. PMID 10844495.
- ↑ Albers LN, Zone JJ, Stoff BK, Feldman RJ (2017). "Rituximab Treatment for Recalcitrant Dermatitis Herpetiformis". JAMA Dermatol. 153 (3): 315–318. doi:10.1001/jamadermatol.2016.4676. PMID 28030659.