Medications
The goals of using medications are to obtain and maintain remission (no symptoms) and to improve quality of life. Each person reacts a little bit differently to each medicine, and many need a combination of drugs. While some of them have side effects, the benefits and symptom relief often outweigh those drawbacks.
Aminosalicylates
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These help control inflammation, especially in those who are newly diagnosed with mild symptoms.
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Sometimes these drugs are called 5-ASA’s, which stands for 5-aminosalyciclic acid.
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Examples include:
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Balsalazide.
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Mesalamine.
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Olsalazine.
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Sulfasalazine.
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Possible side effects include:
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Bloating.
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Diarrhea (loose stool).
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Headaches.
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Heartburn.
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Nausea and throwing up.
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Corticosteroids
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These drugs can be very helpful right away. They help lessen inflammation quickly.
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Corticosteroids are a bridge to starting or continuing another treatment to control UC.
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These are often given in higher doses when the disease is at its worst, then lowered as symptoms get under control. They are given to people with moderate to severe symptoms.
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These drugs are not meant for long-term or repeated use. Examples include:
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Prednisone.
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Budesonide.
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Hydrocortisone.
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Methylprednisolone.
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Possible side effects include:
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Greater risk of infection.
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Bone mass loss.
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Weight gain.
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Acne.
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Facial hair.
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Mood swings.
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Hypertension.
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High blood sugar (diabetes).
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Stopping these drugs suddenly could cause withdrawal symptoms, so your health care provider will have you lower the dose slowly.
Immunosuppressants
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These block the overactive or hyperactive immune reaction that leads to inflammation, lessening swelling in the gastrointestinal (GI) tract.
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These medicines can take up to three months to start working, so they are often used with other medicines until that time.
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These are given to help people go into remission or given to people who have not responded to other treatments.
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Examples include:
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6-mercaptopurine (6-MP).
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Methotrexate.
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Azathioprine.
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Tofacitinib.
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Possible side effects include:
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Nausea or throwing up.
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Diarrhea (loose stool).
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Infections.
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Fatigue or feeling tired.
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Pancreatitis.
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Lymphoma and skin cancer (6-MP and azathioprine).
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Your health care team will closely monitor you on these treatments because the consequences of untreated UC are greater than these risks when your symptoms are very active. However, there are newer agents available that may be safer. This is where shared decision-making is very important.
Biologic treatments
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These drugs can lessen inflammation and quickly bring on remission of UC.
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These drugs are often given by either injection or infusion, based on what the patient needs.
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They tend to cost more, so talk to your health care team and health plan before starting these treatments.
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Examples include (brand names may be different):
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Tumor necrosis factor-alpha (TNF-alpha) antagonists
(infliximab, adalimumab, certolizumab, natalizumab). -
Gut-specific integrin receptor antagonists (vedolizumab).
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Interleukin (IL) 12 and IL-23 antagonists (ustekinumab).
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Possible side effects include:
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Injection or infusion reactions.
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Itching or bruising at injection or infusion site.
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Infections.
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Lymphoma (TNF-alpha).
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Your health care team will closely monitor you on these treatments because the consequences of untreated UC are greater than these risks when your symptoms are very active. However, there are newer agents available that may be safer. This is where shared decision making is very important.
“We have reached the beginning of an era that’s really exciting for ulcerative colitis and Crohn’s disease where we have more treatment options. Just within the last decade, there are multiple new classes of medications that weren’t even available a decade ago, so that’s exciting.” Christina Ha, MD, Inflammatory Bowel Disease Center, Cedars-Sinai, Los Angeles, CA
What is step therapy?
Step therapy happens when a health insurance company decides which treatments it will cover for certain health problems, such as IBD, and in what order.
If you are subject to step therapy, work with your health care provider to try to get the treatment that is best for you.
The AGA GI Patient Center has additional information:
Biosimilar treatments
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Biosimilars have been approved by the U.S. Food and Drug Administration (FDA) to use as treatment in place of existing biologic drugs.
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They are highly similar to the originator biologic but are not an exact copy.
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Biosimilars work the same way as their originator biologics and are given the same way.
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Your health care provider can prescribe a biosimilar as a substitute for a biologic drug; however, in most states, your pharmacist cannot change you from a biologic drug to a biosimilar without your provider’s approval.
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Talk to your health care provider or health insurance plan to better understand the requirements.
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Read more about biologics and biosimilars in the AGA GI Patient Center:
Surgery
Even with the availability of medicines to treat UC, surgery may still be needed to manage the disease. There are a few types of surgery that your gastroenterologist with discuss with you.
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Proctocolectomy: This removes the colon and rectum. Sometimes ileostomy is also done at this time, which is a procedure that brings the ileum, or end of the small intestine, through an opening in the abdominal wall to allow intestinal waste to drain out of the body. After the procedure, the patient wears an external bag over the opening to collect waste.
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Restorative proctocolectomy (also known as ileoanal pouch anal anastomosis): This removes the colon and rectum but allows the patient to continue to pass stool through the anus.
Before having surgery for UC, it is important to understand what the aim of the surgery is, what will happen during the procedure, and the length of the recovery period. Patients with UC having surgery should speak to other patients who have had the procedure. Previous patients are often very willing to share their experiences and add perspective.
There are many tools available to assist you in making decisions about treatment for UC.
Coping with IBD
Though IBD is a long-term health issue that has times of remission and relapse, most people have a normal life span and a good quality of life. For those who have chronic and continuing symptoms, here are a few tips to try:
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Know your body and how IBD affects you.
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Learn to care for yourself — have control over those things you can control.
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Build a support system that works for you: family, friends and support groups.
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Be sure to follow instructions from your medical team.
