IBD Treatment:The Basics

Megan Chan, PGY2UHCMC

5-ASA (Amino salicylic acid)• Uses: – Induction/Maintenance of UC– Very mild CD

• Formulations:– Sulfasalazine = 5ASA + Sulfa– Mesalamine = 5ASA in pH sensitive or time-dependent

capsules• Pentasa—time released duodenum to colon• Asacol—pH released in TI & colon• Lialda—pH released in TI & colon

– Canasa = suppository (effective to 10-15 cm)– Rowasa = enema (effective to splenic flexure)

Steriods• Uses: Induction of UC & Crohn’s– NOT for maintenance, fistulizing/stricturing Crohn’s

• Topical:– Cortifoam/Cortenema—best for proctitis &

proctosigmoiditis– Budesondie (Entocort)—oral pH released in TI &

right colon• IV: – Solumedrol 20mg q8hrs– Hydrocortisone 100mg q8hrs

• PO:– Prednisone 40-60mg with taper over 1-2 months

Biologics (Anti-TNF)

• Infliximab (Remicade)—Crohn’s & UC• Adalimumab (Humira)--Crohn’s & UC• Certolizumab (Cimzia)—Crohn’s • Golimumab (Simponi)—UC

Immunomodulators

• Azathioprine (Imuran)• 6MP (Purinethol)• Methotrexate (MTX)• Cyclosporine (Neoral)*In combination with biologics, these can decrease Ab formation

Leukocyte Trafficking Agents

• Natalizumab (Tysabri)—Crohn’s • Vedolizumab (Entyvio)—UC > Crohn’s

Antibiotics

• Useful in perianal and fistulizing Crohn’s• Flagyl 750-1000mg/day• Cipro 1000mg/day

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