Medications

Inflammatory bowel disease (IBD) is when long-term inflammation occurs in the gut. Crohn’s disease and ulcerative colitis (UC) are common forms of IBD.¹

In general, medications for IBD aim to help a person reach remission and stay there. Remission happens when inflammation is well-controlled. This reduces symptoms of IBD.^1,2

During a flare, drug treatment goals shift to controlling the flare. They may also shift to extending the time between flares.^1,2

What kinds of medications are used to treat inflammatory bowel disease?

The main types of drugs used to treat IBD include:^3,4

• Aminosalicylates
• Antibiotics
• Biologics and biosimilars
• Corticosteroids
• Immunomodulators
• Targeted synthetic small molecules

Aminosalicylates for IBD

Aminosalicylates are drugs that have anti-inflammatory properties. They work by reducing inflammation in the intestinal lining. Aminosalicylates contain 5-aminosalicylic acid, or 5-ASA for short. 5-ASA drugs are often used for people with UC. They are not routinely used for people with Crohn's disease.^5,6

Examples of aminosalicylates used for IBD treatment include:⁵

• Balsalazide (Colazal®)
• Mesalamine (Apriso®, Canasa, Delzicol®, Lialda®, Pentasa®, Rowasa®)
• Olsalazine (Dipentum®)
• Sulfasalazine (Azulfidine®)

Antibiotics for IBD

Antibiotics are a class of prescription drugs commonly used to treat infections. In people with IBD, antibiotics may be used to treat:⁷

• Infections that arise as a complication of IBD itself
• Infections that occur from the drugs used to treat IBD
• Inflammation of the intestines caused by IBD

Examples of antibiotics used for IBD treatment include:⁷

• Ciprofloxacin (Cipro®)
• Metronidazole (Flagyl®)
• Rifaximin (Xifaxan®)
• Vancomycin (Vancocin®)

Biologics for IBD

Biologics are a type of therapy made from complex proteins. They are made from live cells in a laboratory. The proteins used in biologics target specific parts of the immune system. Biologics used for the treatment of IBD are usually antibodies. They target substances in the immune system that drive inflammation.^8,9

At this time, there are 3 types of biologics used to treat IBD:⁸

• Anti-tumor necrosis factor (anti-TNF) medicines
• Integrin receptor antagonists
• Interleukin-12 (IL-12) and interleukin-23 (IL-23) inhibitors

Anti-tumor necrosis factor (anti-TNF) medicines

Examples of anti-TNF biologics for IBD include:⁸

• Cimzia® (certolizumab pegol)
• Humira® (adalimumab)
• Remicade® (infliximab)
• Simponi® (golimumab)

Integrin receptor antagonists

Examples of integrin receptor antagonists include:⁸

• Entyvio™ (vedolizumab)
• Tysabri® (natalizumab)

IL-12 and IL-23 inhibitors

Examples of IL-12 and/or IL-23 inhibitors for IBD include:^8,10,11

• • Omvoh™ (mirikizumab-mrkz)
  • Skyrizi® (risankizumab)
  • Stelara® (ustekinumab)
  • Tremfya® (guselkimab)

Biosimilars for IBD

Biosimilars are drugs that are very similar to an already-approved biologic drug. A number of biosimilars are used in IBD treatment.^8,9,12

Biosimilars of Humira (adalimumab) include:^8,9,12

• Abrilada® (adalimumab-afzb)
• Amjevita™ (adalimumab-atto)
• Cyltezo® (adalimumab-adbm)
• Hadlima™ (adalimumab-bwwd)
• Hulio® (adalimumab-fkjp)
• Hyrimoz® (adalimumab-adaz)
• Idacio® (adalimumab-aacf)
• Simlandi® (adalimumab-ryvk)
• Yuflyma® (adalimumab-aaty)
• Yusimry™ (adalimumab-aqvh)

Biosimilars of Remicade (infliximab) include:^8,9,13,14

• Avsola™ (infliximab-axxq)
• Inflectra® (infliximab-dyyb)
• Ixifi™ (infliximab-qbtx)
• Renflexis® (infliximab-abda)
• Zymfentra™ (infliximab-dyyb)

Biosimilars of Stelara (ustekinumab) include:^8,9,15,16

• Otulfi® (ustekinumab-aauz)
• Pyzchiva® (ustekinumab-ttwe)
• Wezlana™(ustekinumab-auuf)

Corticosteroids for IBD

Corticosteroids help control inflammation and work to keep the immune system in check. They are commonly used as a short-term treatment for IBD flares. They are not recommended for long-term or maintenance therapy because they have many side effects when used over long periods of time.^3,17

Examples of corticosteroids used in IBD treatment include:¹⁷

• Budesonide (Entocort® EC, Uceris®)
• Methylprednisolone (Depo-Medrol®, Medrol Dosepak®, Solu-Medrol®)
• Prednisolone (Pediapred®)
• Prednisone

Immunomodulators for IBD

Immunomodulators work by lessening activity in the immune system. Specifically, they reduce inflammation. Examples of immunomodulators used for IBD include:^18,19

• 6-MP, Purinethol® (6-mercaptopurine)
• Imuran®, Azasan® (azathioprine)
• Methotrexate
• Prograf® (tacrolimus)
• Sandimmune®, Neoral® (cyclosporine A)
• Velsipity (etrasimod tablet)
• Zeposia® (ozanimod)

Targeted synthetic small molecule drugs for IBD

These are small-molecule drugs that target the JAK family of proteins. These proteins are involved in signaling pathways that cause inflammation. Targeted synthetic small molecules prevent these proteins from driving inflammation. There are 2 kinds: JAK inhibitors and S1P receptor modulators. ^20-22

Examples of JAK inhibitors used in IBD treatment include:^20-22

• Tofacitinib (Xeljanz®)
• Upacitinib (Rinvoq®)

Examples of S1P receptor modulators used in IBD treatment include:^20-22

• Velsipity (etrasimod tablet)
• Zeposia® (ozanimod)

Understanding your medicines

Before you start taking any new medicine for your IBD, talk with your doctor. Be sure you understand what the medicine does and how to take it. Tell your doctor or healthcare team if you have any questions or concerns.