Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are conditions that involve inflammation of the gastrointestinal tract. in recent years, Treatment options for IBD It has expanded rapidly. The goal of these new treatments is to improve the control of inflammation in the gut, which can significantly improve patients’ quality of life.
Drug treatment options for IBD
5-aminosalicylate: This class of drugs contains 5-aminosalicylic acid, which works to reduce inflammation in the intestines. Sulfasalazine and mesalamine (available in oral and rectal forms) are often prescribed to patients with mild UC or CD of the colon, but especially in patients with inflammation limited to the rectum and sigmoid colon. Helpful. Although aminosalicylates are generally well tolerated, it is important to closely monitor blood tests (including kidney function) every few months while taking the drug.
Biological products: These drugs target specific proteins and pathways to reduce inflammation in IBD. Biologics, historically reserved for critically ill patients, are now often the first-line approach for patients with CD and UC. This class of drugs is a rapidly evolving field of research, with several clinical trials underway and some newly approved drugs.
- Anti-TNFα therapy: These drugs reduce inflammation by blocking a protein called tumor necrosis factor (TNF) and are used in both CD and UC patients. Infliximab and adalimumab are examples of anti-TNF drugs. Anti-TNF alpha therapy requires frequent blood tests to track response to treatment.Furthermore, an approach called Therapeutic drug monitoringthe drug concentration in the blood is measured and can be used to adjust the drug dosage to suit the needs of the individual patient.
- Anti-IL-12/23: These treatments reduce intestinal inflammation by inhibiting specific pro-inflammatory proteins called interleukin-12 and interleukin-23. Ustekinumab is FDA-approved to treat both UC and CD. Risankizumab was approved by the FDA in June 2022 for the treatment of moderate to severe CD. Clinical trials are underway to evaluate its usefulness in UC.
- Anti-integrin: These drugs block white blood cells that cause inflammation from entering the gastrointestinal tract. Vedolizumab has been shown to be an effective treatment that is well tolerated in patients with IBD. Natalizumab is approved for the treatment of moderate to severe CD but is less commonly used due to its side effect profile.
low molecule: This new class of drugs uses molecules small enough to easily enter cells to alter various inflammatory pathways in the body. One advantage of these treatments is that they are administered orally, making them more convenient for patients.
- JAK inhibitors: These treatments block the activity of Janus kinases (JAKs), which normally work to stimulate the body’s inflammatory response. Tofacitinib is approved for the treatment of moderate to severe UC and is being studied in CD. Upadacitinib has been shown to have high clinical remission rates in UC and was approved by the FDA in March 2022.
- S1P receptor modulator: This class of drugs blocks receptors for a signaling fat molecule called S1P to reduce inflammation and immune responses. Ozanimod was approved in May 2021 for the treatment of moderate to severe ulcerative colitis.
corticosteroid: The use of oral corticosteroids, such as prednisone, was once a mainstay of IBD treatment, but is now typically limited to short-term use in patients with active flare-ups. These drugs are associated with an increased risk of infections, blood clots, bone thinning, and high blood sugar levels, among other undesirable side effects. One particular type of oral corticosteroid, called budesonide, is released primarily in the gastrointestinal tract and has few side effects.
immunomodulator: These drugs reduce inflammation in the gastrointestinal tract by suppressing the immune system and are effective in treating both CD and UC. Examples include azathioprine, methotrexate, 6-mercaptopurine, tacrolimus, and cyclosporine. However, its use as a first-line treatment has declined due to side effects such as bone marrow suppression, increased risk of certain blood cancers, liver damage, and gastrointestinal intolerance.
In some cases, these drugs are used in low doses in combination with biologics to optimize treatment effectiveness and prevent the formation of anti-drug antibodies against the biologic. Patients taking these drugs require regular blood tests for monitoring.
Which treatment is right for me?
Treatment plans for IBD are complex and individualized for each patient. Past medical history, severity and location of the disease, type of IBD, and response to past treatments are some of the many factors that go into determining which drug is right for you.
To evaluate treatment, doctors will continue to use a combination of symptoms, blood tests, stool tests, imaging tests, and endoscopy (upper endoscopy and/or colonoscopy) to determine if treatment is working. or whether adjustments are needed. In some cases, this means changing the dosage or frequency of your current medication, adding a second medication, or starting a different type of treatment. The goal is to find a drug that works for you long-term and achieve clinical remission.
What if I can’t afford the recommended treatment?
There are several options to reduce the cost of IBD treatment. Your doctor can work with you to see if the drug manufacturer offers it. Patient Financial Assistance Program A service that provides medicines at discounted prices. In addition, physicians may work with insurance companies to prescribe more affordable biosimilars (medicines with similar structure, function, and clinical effects as standard biologics).
In some cases, forgetting a drug dose can trigger the production of anti-drug antibodies, which can make patients more susceptible to severe allergic reactions when they start taking the drug again. Additionally, medication gaps may make IBD patients more susceptible to complications such as flare-ups and surgery and hospitalization. For these reasons, it is important to work with your doctor, your insurance company, and the manufacturer of the medicine you are taking to minimize the time between doses of your medicine.
Crohn’s disease and ulcerative colitis are chronic, lifelong illnesses. However, once remission is achieved, most people have an excellent quality of life. Furthermore, each patient’s symptom course is different. If you are concerned about the cost or safety of your medication, or are considering stopping your medication, talk to your doctor to discuss a personalized solution.