Types of Medications for Crohn's Disease and Ulcerative Colitis
The medical treatment of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis has three main goals:
- Achieving remission (the absence of symptoms)
- Maintaining remission (prevention of symptoms or flare-ups)
- Improving your quality of life
To accomplish these goals, treatment is aimed at controlling the ongoing inflammation in the intestine— the cause of IBD symptoms. There is no standard approach to managing all people with IBD. The symptoms, severity of disease, and how the disease might impact a person down the road vary considerably.
Your healthcare provider will work with you to help decide the right treatment for you. It may take some time for medications to take effect, or sometimes a medication may stop working. The management of Crohn's disease and ulcerative colitis involves dedication to taking your medications as prescribed, and maintaining open communication with your healthcare team so you can work together towards achieving remission.
There are many medications available to help control your disease symptoms and inflammation. IBD medications generally fall into the following categories:
Many of the same medications used for adults are also used in children with IBD. However, there may be special considerations taken when these medications are prescribed. Additionally, women who are pregnant, planning to become pregnant, or breastfeeding should also discuss their medication options with their healthcare team.
UNDERSTANDING TREATMENT OPTIONS IN IBD
Be sure to talk to your doctor about the potential risks and side effects of these medications and weigh them against the potential benefits. The following webinar highlights IBD medication options and the importance of participating in shared decision-making with your healthcare team to determine the plan that is best for you.
View the categories below to learn more about your medication options.
Aminosalicylates limit the inflammation in the lining of the digestive (also known as the gastrointestinal) tract. They are mainly used to treat mild-to-moderate ulcerative colitis and sometimes Crohn’s disease.
Aminosalicylates can be pills, enemas, or suppositories (inserted through rectum). The type taken depends on several factors, including where in your digestive tract your inflammation is located.
Learn more about aminosalicylates in the resources below:
Corticosteroids lower the activity of your immune system and limit the inflammation in the digestive tract. They are used as short-term treatments of Crohn's disease and ulcerative colitis flares because they reduce inflammation quickly, sometimes within a few days to a few months. It is important to note that corticosteroids are not considered long-term therapies due to the high potential of side effects. Corticosteroids can be taken orally, rectally, or via an injection depending on which medication you take.
Learn more about corticosteroids in the resources below:
Immunomodulators work to calm your immune system over an extended period of time. They are often used as a long-term treatment for those with IBD. Since it may take 3-6 months (or longer) before their impact is seen, immunomodulators are often started at the same time as faster-acting corticosteroids with the idea that patients will stop taking steroids once immunomodulators take effect. They also may be used in combination with other agents, such as biologics, and can be injected or taken in pill form depending on the medication.
Learn more about immunomodulators in the resources below:
Antibiotics are prescribed to treat many types of infections that patients with IBD may suffer from. For complications of Crohn’s disease like abscesses (pockets of pus) and fistulae (abnormal connections of the intestine to other parts of the body), antibiotics are very helpful. Antibiotics are also frequently used post-operatively to prevent infection.
Clostridium difficile (also known as C. difficile or C.diff) is a bacteria that attacks the intestine and can cause fever, abdominal pain, cramping, diarrhea and bloody stools. Though anyone can acquire C. difficile, those with IBD are especially prone to this bacterial infection. C. difficile requires antibiotic treatment to get rid of it.
Antibiotics may be taken by mouth or through an intravenous infusion, depending on the physician’s recommendation. And of course, patients with IBD, like everyone else, get infections outside of the digestive system from time to time. Some patients with IBD may be especially prone to infections if they have a weakened immune system from the medications they take to manage their IBD. In certain instances, these infections may require a course of antibiotic treatment.
Learn more about antibiotics in the resources below:
Biologic therapies (also known as biologics) are proteins that block the action of specific molecules in the body that are involved in causing inflammation. These medications are indicated for people with a moderately to severely active form of IBD who have not responded well to other types of medications, or for those who are at high risk of complications from the disease. Biologics can be delivered through injection or intravenously (depending on the medication being used). There are several types of biologic medications depending on the specific proteins that are being targeted.
Biosimilars are similar, near identical copies of other already approved biologic therapies, known as the reference product or originator biologic. They are drugs that act just like a reference product, having the same effectiveness and safety in the patient population that it treats.
Learn more about biologic therapies in the resources below:
Janus kinase (JAK) inhibitors are immunosuppressants that function by binding and blocking the JAK enzyme from activating certain types of immune system cells that cause inflammation. JAK inhibitors are currently FDA-approved to treat moderate-severe ulcerative colitis. These medications are taken orally as a pill.
Learn more about JAK inhibitors in the resources below:
WHY IS IT IMPORTANT TO TAKE MEDICATIONS AS PRESCRIBED?
Living with Crohn's disease and ulcerative colitis can be challenging as you face disease symptoms and cope with daily life. It is important to understand your role in keeping your symptoms and inflammation under control.
Medications can help keep your disease under control and can help prevent complications, such as surgery, hospitalization, flare-ups, and risk of cancer due to uncontrolled inflammation. Medications work best when taken consistently and as prescribed. While there are often concerns about medication side effects, the risk of developing complications from not taking medication is generally greater than the risk of developing medication side effects.
There may be times where a medication may not seem to be working, or new symptoms or complications still arise. What works at one stage of your disease may not work at another. If you are experiencing IBD symptoms while on treatment, you should inform your doctor as soon as possible. During these conversations, you should feel comfortable asking about other available treatment options as well as their benefits and risks. Becoming an active member of your healthcare team will help you and your doctor come up with the best treatment strategy to help you achieve remission and improve your quality of life.
What is shared decision-making?
Shared decision-making is a process where you and your healthcare team work together to decide your treatments based on medical evidence and your personal preferences1.
Why is shared decision-making important?
No decision about you, without you! Since everyone’s disease is different, the best treatment decision is the one that meets your goals or needs. It is important that you and your healthcare team work together to find a treatment plan that is right for you. While your provider may know what’s going on inside your gut, they may not know what’s going on inside your head. It is only when you are involved in the decision-making process that you can make the best choice for you.
What are the key steps in shared decision-making?
When discussing treatment options with your provider, follow the steps below2:
- Information: Gather all the information about available treatment options, including the pros/cons and risks and benefits of all treatment options.
- Support: Share your personal goals, values, and preferences with your healthcare team and ask for support as you think through all your options.
- Discuss: Talk through all your options with your healthcare team and make a decision together based on medical evidence and your own personal wants and needs.
- Follow through: After making your decision, remain in contact with your provider and ask any follow up questions you may have.
What are the benefits of shared decision-making?
Patients who participate in shared decision-making are more satisfied with their healthcare treatment and more confident in their choice of treatment. They fully understand the risks and benefits of treatment, are happier with the care they receive, and are more likely to follow up with the treatment plan they agreed to with their healthcare team.
Additional resources to help you talk to your doctor about your treatment options:
- IBD Symptom Tracker: Use this document to help you track your IBD symptoms and share it with your healthcare team at every visit.
- Medication discussion guide for IBD patients: a document that guides you on questions to ask your doctor when discussing possible IBD medications.
- Decision making tool for IBD treatment: Online tools explain the pros, cons, and tradeoffs of various treatments. Armed with this information, you'll be better equipped to discuss the options with your doctor and make the right decision.
- Coulter, A and Collins A. 2011. Making shared decision-making a reality: no decision about me, without me. (pdf) London: The Kings Fund. Available at http://www.kingsfund.org/uk/publications/nhs_decisionmaking.html
- Shared Decision Making: Engaging Patients to Improve Health Care © May 2013 by Families USA
- Lofland JH, Johnson PT, Ingham MP, et al. Shared decision-making for biologic treatment of autoimmune disease: influence on adherence, persistence, satisfaction, and health care costs. Patient Prefer Adherence 2017;11:947-958.
- Mahlich J, Matsuoka K, Sruamsiri R. Shared Decision Making and Treatment Satisfaction in Japanese Patients with Inflammatory Bowel Disease. Dig Dis 2017;35:454-462.
For further information, call Crohn's & Colitis Foundation's IBD Help Center: 888.MY.GUT.PAIN (888.694.8872).
The Crohn's & Colitis Foundation provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization's resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.
About this resource
By: Crohn's & Colitis Foundation
Published: April 7, 2017