Medical Therapy to Treat IBD

Prednisone, Prednisolone, Methylprednisolone, Budesonide

These medications are induction therapies for moderate to severe IBD, and have been used for over 50 years. They are usually used short term (a few weeks to a few months) to get moderate to severe Crohn’s Disease or ulcerative colitis under control. Some of these medications have significant side effects while others do not because of different absorption and processing in the body.

Sulfasalazine, Olsalazine, Mesalamine, Balsalazide

These are among the safest medications used to treat IBD, but are generally effective only in milder cases. They are most effective as maintenance therapies in mild to moderate ulcerative colitis.

Metronidazole, Ciprofloxacin (Cipro®)

Antibiotics are often used to treat infectious complications of inflammatory bowel disease; such as abscesses in the abdomen or around the anus (perianal). They also may be used to treat mildly active Crohn’s Disease and are sometimes utilized to treat mild flares of ulcerative colitis.

Azathioprine AZA and 6-mercaptopurine (6MP)

These two medications are primarily used as maintenance treatment in Crohns’ disease, and have been used for over 25 years. They are also used in patients with ulcerative colitis whose symptoms persist despite the use of amniosalicylates (see above). These medications typically take 3-6 months to be effective.

Methotrexate

Methotrexate is another immunomodulatory medication used as a maintenance therapy for Crohn’s disease. This medicine typically takes 4 weeks before it may be effective.

Cyclosporine (Gengraf ®, Neoral ®, Restasis ®, and Sandimmune ®) and Tacrolimus (Prograf ®)

Cyclosporine and tacrolimus are medications that may be used short term to induce a remission in Crohn’s or ulcerative colitis patients with severe symptoms and persistently active disease despite conventional treatments.

Infliximab (Remicade®), Adalimumab (Humira®), Golimumab (Simponi®) Certolizumab pegol (Cimzia®)

Anti-TNF agents are usually used in patients with moderate to severe IBD.

Vedolizumab (Entyvio®), Natalizumab (Tysabri®)

Anti-Integrin agents are usually used in patients with IBD who have not responded to corticosteroids, immunomodulators, and anti-TNF agents. These agents frequently take a longer time (months) to see a clinical effect.

Ustekinumab (Stelara®)

Anti-Interleukin agents are usually used in patients with IBD who have not responded to corticosteroids, immunomodulators, and anti-TNF agents.