| Category | Examples (US Brand Names) | Mechanism of Action | Side Effects | Monitoring |
|---|---|---|---|---|
| Immunomodulator therapy | Thiopurines Azathioprine (Imuran, Azasan) 6-Mercaptopurine (Purinethol) | Interferes with de novo synthesis of purine ribonucleotides, leading to decrease in immune cell production8 | Common: Gastrointestinal: nausea, vomiting, abdominal pain, hepatotoxicity, pancreatitis Allergic: fever, rash, arthralgia Hematologic: leukopenia | CBC and LFTs every 4–12 weeks |
| Uncommon: Hematologic: lymphoma, nonmelanoma skin cancer | ||||
| Methotrexate (Rheumatrex, Trexall) | Multiple anti-inflammatory effects, including blocking production of IL-1, IL-2, IL-6, IL-816 | Common: General: stomatitis, hair loss Gastrointestinal: nausea, diarrhea Hematologic: leukopenia Obstetric: teratogen, abortifacient | LFT every 1–3 months, periodic CBC | |
| Uncommon: Gastrointestinal: hepatic fibrosis Pulmonary: interstitial pneumonitis | ||||
| Biologic Therapy | Anti-TNF-α Infliximab (Remicade) Adalimumab (Humira) Certolizumab pegol (Cimzia) | Neutralization of TNF-α, along with specific molecular effects, leading to reduced immune response25 | Common: General: intravenous infusion reaction (chest pain, dyspnea, rash, hypotension), fatigue Dermatologic: subcutaneous injection site reaction and pain Rheumatologic: polyarthralgia Infectious disease, particularly granulomatous | Annual tuberculosis testing, periodic LFTs, CBC, and renal function tests |
| Anti-α-4 integrin Natalizumab (Tysabri) | Blocks integrin, which reduces leukocyte adhesion and migration into inflamed gut22,23 | |||
| Uncommon: Hematologic: lymphoma, hepatosplenic T-cell lymphoma (particularly in young males taking biologics and immunomodulators) Rheumatologic: antinuclear antibody formation, anti-double stranded DNA Neurologic: demyelination, polyneuropathy, progressive multifocal leukoencephalopathy (natalizumab) |
CBC, complete blood count; IL, interleukin; LFT, liver function test; TNF, tumor necrosis factor.