Medications to treat inflammatory bowel disease (IBD) often reduce inflammation and promote intestinal healing, leading to remission, or long-term relief of symptoms. However, for many people with IBD, the condition is chronic and treatment is lifelong. It is important to follow up regularly with your gastroenterologist.
corticosteroid drugs
Corticosteroid medications are powerful anti-inflammatory agents that are often used short-term to quickly relieve symptoms. They are also helpful as a "bridge" to long-term treatment, because some IBD medications are more effective if used after symptoms are controlled.
Corticosteroids can be taken by mouth, enema, or intravenously (IV).
5-aminosalicylic acid drugs
Doctors may prescribe 5-aminosalicylic acid medication (called 5-ASA) for people with mild to moderate IBD. 5-ASA is more effective in ulcerative colitis but is sometimes used in people with Crohn's disease.
These medications can reduce inflammation in the lining of the intestines and relieve abdominal pain, diarrhea, and other symptoms. They are available as pills, enemas, or suppositories. Your doctor will recommend the form that's right for you based on the area of your gastrointestinal tract affected.
5-ASA may help achieve and maintain IBD remission, so your doctor may recommend taking them daily as part of a long-term treatment plan.
For example: Mesalazine. Mesalazine is often used as a first-line drug in people with ulcerative colitis and some people with Crohn's disease. Doctors regularly test the kidneys of people taking mesalamine, but side effects are uncommon. Mesalazine is available in many brands with different dosage regimens and tablets. Patients who have difficulty remembering to take their medications should discuss this issue with their physician.
Azathioprine (Imuran®), 6-mercaptopurine (Purinethol®), and methotrexate
These drugs are often called "immunomodulators." They work by reducing the number or activity of cells that cause inflammation in the gut. They have been used for years to treat conditions such as rheumatoid arthritis, in patients undergoing organ transplants, and in chemotherapy for certain cancers. There are some uncommon side effects, such as inflammation of the liver or pancreas, that can be detected with blood tests. There is also a slightly increased risk of infection and a blood cancer called lymphoma. Methotrexate is not safe during pregnancy, so patients planning to have children should consult your doctor before using methotrexate. Despite these risks, we often use these medications to treat inflammatory bowel disease because they are safer than long-term or frequent use of steroids.
immunomodulator
Immunomodulatory drugs suppress or modulate certain aspects of the immune system, counteracting the body's abnormal responses to foods and bacteria in the digestive tract. They can reduce symptoms, sometimes by reducing intestinal inflammation. Doctors may prescribe these medications long-term for people with mild to moderate IBD.
Typically, immunomodulators are prescribed after a course of corticosteroid drugs has been taken and symptoms have been controlled. They can be taken orally or injected. Your gastroenterologist will determine what works best for you and can teach you how to give the injections every two weeks at home.
Your physician will monitor the effectiveness of this therapy during regular follow-up visits. During these visits, imaging tests or endoscopy can show whether the digestive tract is responding to medications. If these drugs improve your health and relieve symptoms, treatment may last for several years.
Some immunomodulators are better for Crohn's disease, while others are more effective for ulcerative colitis. Your doctor can determine which medication is best for you.
Natalizumab (Tysabri®)
Natalizumab is a drug that blocks the ability of white blood cells that cause inflammation to reach the lining of the gut. If the cells don't reach your intestinal wall, the inflammation may be reduced. This medication is given by intravenous infusion. Increased risk of infection. A rare but serious risk with this drug is progressive multifocal brain lesions (PML). This is caused by a viral infection in the brain and can be very serious. Only one case of PML has developed in patients receiving natalizumab for Crohn's disease, and the risk is estimated to be 1 in 1,000.
biological therapy
Biological therapies, sometimes called biologics, are a class of drugs that reduce intestinal inflammation by targeting specific immune system responses. There are two categories of biologics used to control symptoms of IBD: anti-TNF drugs and anti-integrin drugs. These drugs are usually taken long-term, sometimes along with immunomodulators.
Infliximab (Remicade®), adalimumab (Humira®), and Certolizumab Pegol (Cimzia®)
These drugs are often called "biologics." They both block the effects of a chemical called tumor necrosis factor alpha (TNF-alpha). By blocking TNF-α, they reduce the activity of cells that cause inflammation. These drugs are given through a vein or injection. These drugs may increase the risk of infections and a blood cancer called lymphoma. Despite these risks, we often use these medications to treat inflammatory bowel disease because they are safer than long-term or frequent use of steroids.
anti-tumor necrosis factor drugs
If IBD is moderate to severe at the time of diagnosis, or your symptoms don't respond to other medical treatments, a gastroenterologist may prescribe anti-TNF drugs, which block proteins that cause inflammation in the digestive tract. Anti-TNF drugs may also be given if conditions such as fistulas (holes that form between the intestines and other organs) pose an immediate risk to your health.
Anti-TNF drugs are given by injection using a syringe or by intravenous infusion. If your doctor prescribes injectable medications, he or she will show you how to take them at home.
If intravenous infusion is right for you, experts can help you schedule an appointment at one of NYU Langone's infusion centers in Manhattan and Brooklyn. Doctors give intravenous fluids by inserting a long, flexible tube called a catheter into a vein in your arm. Once in place, the doctor injects medication into the catheter. Anti-TNF infusion takes approximately two hours.
Gastroenterologists determine the frequency of IV infusions based on a variety of factors, including the severity of the disease.
anti-integrin therapy
Anti-integrin therapy may be used in patients with severe IBD whose symptoms have not responded to other medications. This therapy prevents inflammation-causing white blood cells (called lymphocytes) from binding to the lining of the gastrointestinal tract.
Anti-integrin drugs are given via intravenous infusion. The duration of infusion therapy ranges from 30 minutes to 2 hours, depending on the drug administered.
The appropriate frequency of anti-integrin IV infusions varies among individuals. Your gastroenterologist will recommend the most effective schedule for you based on certain factors, including the severity of your disease.
Combination medication
As part of a comprehensive, personalized medical plan, your gastroenterologist may prescribe or recommend medications that are not designed to address the cause of IBD. Instead, it can be used to resolve complications, relieve pain, or address nutritional deficiencies. These medications are recommended in addition to medications that reduce inflammation.
antibiotic
If bacterial infection is a complication of IBD, your doctor may prescribe antibiotics, either by mouth or intravenously. Your gastroenterologist will advise you on the appropriate length of time to take antibiotics based on the severity of the infection.
antispasmodic
For abdominal pain that does not respond to other IBD medications, a gastroenterologist may recommend a prescription antispasmodic medication, which suppresses intestinal muscle spasms and relieves pain and discomfort.
painkiller
Ideally, medications that address the cause of abdominal discomfort will also reduce pain symptoms. If IBD medications don't relieve discomfort, your doctor may recommend over-the-counter pain relievers, such as acetaminophen.
Doctors do not recommend the use of over-the-counter or prescription nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen, naproxen, and aspirin. This is because NSAIDs may increase the risk of stomach ulcers and gastrointestinal bleeding.
vitamin and mineral supplements
People with inflammatory bowel disease often have vitamin or mineral deficiencies because digestive dysfunction prevents the body from absorbing important nutrients. These include iron, folate, vitamin D and vitamin B12. As part of your treatment at NYU Langone Center for Inflammatory Bowel Disease, a dietitian may recommend dietary changes. They may also recommend supplementing your diet with vitamins and minerals to promote your digestive health.
