Chapter 41. Inflammatory Bowel Disease
Which of the following medications is indicated for the treatment of ulcerative colitis, but not Crohn disease?
Answer a is correct. Golimumab is currently approved by the FDA for the treatment of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis. It has not been approved for Crohn disease.
Answer b is incorrect. Infliximab is indicated for the treatment of ulcerative colitis and Crohn disease.
Answer c is incorrect. Adalimumab is indicated for the treatment of ulcerative colitis and Crohn disease.
Answer d is incorrect. Ustekinumab is indicated for the treatment of ulcerative colitis and Crohn disease.
Which of the following medications is appropriate as an initial therapy in mild ulcerative colitis of the distal colon?
Answer c is correct. Rowasa (mesalamine) is an enema preparation effective for mild to moderate ulcerative colitis of the distal colon.
Answer a is incorrect. Vedolizumab is indicated for both moderate to severe disease caused by Crohn disease and ulcerative colitis. It is not indicated as initial therapy in mild disease.
Answer b is incorrect. Methotrexate is indicated for Crohn disease. It has not been shown to be effective in ulcerative colitis.
Answer d is incorrect. Tysabri (natalizumab) is indicated for moderate to severe Crohn disease and not ulcerative colitis. Use is limited due to risk of adverse effects.
JP is a 32-year-old male patient with a diagnosis of mild to moderate Crohn disease of the ileum. He is now trying to titrate off corticosteroids and would like to try methotrexate therapy. What is the appropriate route and dose of methotrexate in this patient?
a. Intravenous (IV) infusion of 25 mg weekly
b. Subcutaneous (SQ) injection of 25 mg daily
c. SQ injection of 25 mg weekly
d. Intramuscular injection of 15 mg three times weekly
Answer c is correct. Methotrexate is initiated at 25 mg SQ weekly then may consider decrease down to 15 mg weekly SQ if symptom-free for 4 months.
Answer a is incorrect. Methotrexate is not given IV for CD.