Inflammatory bowel disease (IBD) is a chronic (long-term) condition that causes inflammation in the digestive tract. The two main forms of IBD are Crohn’s disease (CD) and ulcerative colitis. Although there is currently no cure for IBD, there are many medications available that can:
- Help to treat and manage the symptoms of active IBD during flare-ups
- Help to keep IBD in remission, and increase the time between flare-ups
What kinds of medications are used to treat inflammatory bowel disease?
There are five categories of medications that are used to treat IBD and help manage a patient’s symptoms:1
Patients may need to try a range of different types or combinations of medications before they find a treatment regimen that works effectively for them. Furthermore, a treatment regimen that works well for a patient for one time period may not work as well in the future, because the disease is constantly changing over time. Patients may need to go through various periods of adjusting medications, or trying new types of medications, in order to find the most effective regimen at different times.
What are aminosalicylates?
One type of treatment for IBD is a class of drugs called “anti-inflammatories,” which reduce inflammation in the body.1,2 Aminosalicylates are special type of anti-inflammatory drug that are often prescribed to people with inflammatory bowel diseases. Aminosalicylates contain 5-aminosalicylic acid, which is called “5-ASA” for short. 5-ASA can help to reduce inflammation in the digestive tract by working directly on the lining of the bowel of the digestive tract.
Types of aminosalicylate medicines that are used to treat IBD include:
- Sulfasalazine (brand name: Azulfidine, Azulfidine-EN)
- Mesalamine (brand names: Asacol, Pentasa, Apriso, Lialda, Delzicol, Asacol HD, Rowasa, Canasa)
- Balsalazide (brand names: Colazal)
- Olsalazine (brand name: Dipentum)
Aminosalicylate medications are generally used as maintenance treatment for people with mild-to-moderate IBD, which means that they are taken regularly to help manage the disease and reduce symptoms over the longer term.
What are corticosteroids?
Corticosteroids are another type of anti-inflammatory medication.3 Unlike aminosalicylates, however, corticosteroids are not used in the long term to help manage the disease due to the serious side effects that they can cause. Instead, corticosteroids are generally used for:
- Short-term treatment to help relieve moderate or severe symptom flare-ups
- Helping the patient to enter remission more quickly
There are many different types of corticosteroids; some of the ones that are most commonly used in treating people with IBD include:
- Methylprednisolone (brand name: Medrol)
- Hydrocortisone (brand names: Proctofoam, Cortenema)
- Budesonide (brand name: Entocort, Uceris)
What are antibiotics?
Antibiotics are medicines used to fight bacterial infections by either killing bacteria, or stopping the bacteria from reproducing.4 Antibiotics are generally used in one of two ways for treating IBD:
- As short-term therapy to treat complications of IBD, such as abscesses or wound infections
- As longer-term therapy for people with mild or moderate IBD
Antibiotics that are most commonly used in treating IBD are:
What are immunomodulators?
Immunomodulators are a different type of medication, which work by changing the way that the immune system carries out its functions in a person’s body.5 Because IBD is a disease of the immune system, these medications can be helpful in reducing inflammation and improving symptoms in people with moderate-to-severe disease. Because immunomodulators are very powerful medications that can cause some serious side effects, patients will usually try treatment with them if they find that treatment with other medications, such as antibiotics, corticosteroids, and/or aminosalicylates, does not work well enough.
Types of immunomodulators used to treat IBD include:
- Azathioprine (brand name: Imuran)
- 6-mercaptopurine (6-MP) (brand name: Purinethol)
- Cyclosporine (brand names: Gengraf, Neoral, Sandimmune)
- Tacrolimus (brand name: Prograf)
- Methotrexate (brand name: rheumatrex)
What are biologic therapies?
Biologic therapies, or “biologics,” are a relatively new form of treatment for people with moderate-to-severe IBD.6 These medications are produced from living organisms in a laboratory and contain antibodies to specifically target and interfere with the process of inflammation that IBD causes. By reducing inflammation at its source, biologic therapies can relieve the symptoms that inflammation causes. Biologics can be very effective for some people with IBD, but they are also linked to some serious side effects. For this reason, they are usually only recommended for people who have already tried treatment with aminosalicylates, antibiotics, corticosteroids, or immunomodulators, but those medicines do not work well enough or cause adverse side effects.
There are three categories of biologic therapies that are used to treat people with moderate-to-severe IBD: anti-tumor necrosis factor (anti-TNF) medicines, integrin receptor antagonist medicines, and interleukin 12 and 23 antagonists.
Anti-TNF medicines include:
- Infliximab (brand name: Remicade)
- Renflexis, Inflectra (Remicade biosimilars)
- Adalimumab (brand name: Humira)
- Certolizumab pegol (brand name: Cimzia)
- Golimumab (brand name: Simponi)
Integrin receptor antagonists include:
- Natalizumab (brand name: Tysabri)
- Vedolizumab (brand name: Entyvio)
Interleukin 12 and 23 antagonists include:
- Ustekinumab (brand name: Stelara)
On May 30th, 2018, the United States Food and Drug Administration (FDA) announced that it had expanded its approval of Xeljanz (tofacitinib) to include treating adults with moderate to severe active ulcerative colitis. It is the only FDA approved oral medication for the treatment of adults with this condition. Tofacitinib works as a Janus kinase (JAK) inhibitor. JAKs are enzymes, proteins, found in many cells in the body including stem cells, bones, and joints.7,8,9,10 They regulate the signals that help to activate the body’s immune response system. Tofacitinib inhibits JAK-1 and JAK-3, which helps block receptors that otherwise, can trigger inflammation.7,8,9