While there is currently no cure for Crohn’s disease or ulcerative colitis, doctors can prescribe medications to control inflammation and ease symptoms. There are many medications approved to treat IBD, including:
5-ASAs: aminosalicylates
Also called mesalamines, are anti-inflammatory, non-immunosuppressive pills, enemas, and suppositories, indicated for mild-to-moderate ulcerative colitis. They are rarely used in mild Crohn’s disease.
Corticosteroids
Are hormones produced by the adrenal glands and come in pill, foam, enema or suppository form. They are anti-inflammatory and work by suppressing the immune system. Steroids carry a high side effect profile so they are often used as a bridge to a safer, longer-term medication therapy in IBD.
Antibiotics
Are used to curb the proliferation of intestinal bacteria and thereby quell IBD flares. This can be a result of sepsis caused by complications of Crohn’s disease, including abscesses, fistulae and strictures. Antibiotics may also be a treatment for pouchitis, a complication after J-Pouch/IPAA surgery in ulcerative colitis. Antibiotics must be carefully administered as patients can develop antibiotic resistance and C. difficile infection from overuse.
Immunomodulators
Are used to curb inflammatory response and are effective steroid-sparing therapies used in moderate-to-severe cases of IBD. There are oral immunomodulators as well as injectable ones, which can take approximately 2-3 months to start working.
Biologics
Are advanced medications that target certain proteins to treat inflammation and prevent complications. Biological therapies are steroid-sparing therapies used to treat moderate-to-severe cases of IBD. They come in the form of injectables and/or intravenous infusions. The most commonly used biologics for IBD include anti-TNF agents and agents that target IL-12 and IL-23 pathways.
Small Molecules
Are compounds that come in pill form and are directed at inflammation-causing pathways in moderate-to-severe IBD. The most commonly used small molecules currently include Janus-Kinase (JAK) inhibitors and sphingosine-1-phosphate (S1P) receptors.
The class of medications a gastroenterologist prescribes depends on each individual’s severity of the disease. Deciding on a treatment option should be a shared decision amongst the doctor, the patient, and the patient’s caregivers (pending insurance approval, if applicable).
Written by Tina Aswani Omprakash. Medically reviewed and validated by Jordan Axelrad, MD, MPH. These webpages are funded by a grant from The Leona M. and Harry B. Helmsley Charitable Trust.
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