Inflammatory Bowel Disease
How Is Inflammatory Bowel Disease Treated? continued...
Doctors frequently take a stepwise approach to the use of medications for inflammatory bowel disease. With this approach, the least harmful drugs or drugs that are only taken for a short period of time are used first. If they fail to provide relief, drugs from a higher step are used.
Treatment typically begins with aminosalicylates, which are aspirin-like anti-inflammatory drugs such as sulfasalazine (Azulfidine), olsalazine (Dipentum), balsalazide (Colazal), and mesalamine (Asacol, Lialda, Pentasa, Apriso). Mesalamine can be taken orally or be administered as a rectal suppository or enema to treat ulcerative colitis. Because they are anti-inflammatory, they are effective in both relieving symptoms of a flare-up and maintaining remission. The doctor may also prescribe anti diarrheal agents, antispasmodics, and acid suppressants for symptom relief. You should not take anti-diarrheal agents without a doctor’s advice.
If you have Crohn's disease, especially if it's accompanied by a complication such as perianal disease (diseased tissue around the anus), the doctor may prescribe an antibiotic to be taken with your other medicines. Antibiotics are less commonly used for ulcerative colitis.
If the first drugs don't provide the adequate relief, the doctor will likely prescribe a corticosteroid, which is rapid-acting anti-inflammatory agent. Corticosteroids tend to provide rapid relief of symptoms along with a significant decrease in inflammation. However, because of side effects associated with their long-term use, corticosteroids are used only to treat flare-ups and are not used for maintaining remission.
Immune modifying agents are the next drugs to be used if corticosteroids fail or are required for prolonged periods. These medications are not used in acute flare-ups, because they may take as long as 2 to 3 months to take action. These medications target the immune system, which releases the inflammation-inducing chemicals in the intestine walls, rather than treating the inflammation directly. Examples of the most common immunosuppressives are azathioprine (Imuran), methotrexate (Rheumatrex), and 6-mercaptopurine, or 6-MP (Purinethol).
Biologic therapies are antibodies that target the action of certain other proteins that cause inflammation. Infliximab (Remicade) and infliximab-dyyb (Inflectra), a biosimilar to Remicade, are drugs approved by the FDA to treat moderate to severe Crohn's disease when standard medications have been ineffective. It belongs to a class of drugs known as anti-TNF agents. TNF (tumor necrosis factor) is produced by white blood cells and is believed to be responsible for promoting the tissue damage that occurs with Crohn's disease. Other anti-TNF agents approved for Crohn's disease are certolizumab (Cimzia), and adalimumab (Humira). Cimzia, Humira, Inflectra, Remicade and Simponi are anti-TNF drugs currently approved by the FDA for ulcerative colitis. An alternative to anti-TNF treatment are biologics that target integrin, two of which are natalizumab (Tysabri) and vedolizumab (Entyvio). They are used to treat Crohn's.
If you are not responding to the drugs recommended for IBD, talk with your doctor about enrolling in a clinical trial. Clinical trials are the way new treatments for a disease are tested to see how effective they are and how patients respond to them. You can find out about clinical trials at the Crohn's & Colitis Foundation of America web site.