1. Aminosalicylates (5-ASAs)
These drugs are primarily used for mild to moderate ulcerative colitis and sometimes for Crohn's disease.
- Mesalamine: The most common 5-ASA. It is available in various formulations, including oral tablets, extended-release capsules, and rectal suppositories or enemas. Mesalamine acts topically on the colonic mucosa to reduce inflammation.
- Sulfasalazine: A combination of sulfapyridine and 5-ASA, it was one of the first treatments for IBD but is less commonly used today due to side effects related to the sulfapyridine component.
- Olsalazine: Another 5-ASA compound used for ulcerative colitis, it is less effective for Crohn's disease.
- Balsalazide: A pro-drug that converts to 5-ASA in the colon. It is used for ulcerative colitis.
2. Corticosteroids
Corticosteroids are potent anti-inflammatory agents used for short-term management of moderate to severe IBD flares.
- Prednisone: Commonly used for acute flares. It is effective in reducing inflammation but not suitable for long-term use due to side effects like weight gain, diabetes, and osteoporosis.
- Budesonide: A corticosteroid with a more localized action in the gut, reducing systemic side effects. It is used for mild to moderate Crohn's disease and ulcerative colitis.
- Hydrocortisone: Used rectally (as an enema or suppository) for ulcerative colitis. Systemic forms are also used for severe cases.
3. Immunomodulators
These drugs modify the immune response and are used for long-term maintenance therapy.
- Azathioprine and 6-Mercaptopurine: Purine analogs that inhibit purine synthesis, leading to reduced immune cell proliferation. They are used to maintain remission and reduce steroid dependency.
- Methotrexate: An antimetabolite that inhibits folic acid metabolism. It is used primarily for Crohn's disease and can be effective in steroid-dependent cases.
- Cyclosporine: An immunosuppressant that inhibits T-cell activation. It is generally used for severe cases unresponsive to other treatments.
4. Biologics
Biologics are targeted therapies that inhibit specific inflammatory pathways. They are used for moderate to severe IBD, particularly when other treatments fail.
- Anti-TNF Agents: These drugs inhibit tumor necrosis factor-alpha (TNF-α), a key mediator in inflammation.
- Infliximab: Administered intravenously.
- Adalimumab: Administered subcutaneously.
- Certolizumab pegol: Administered subcutaneously.
- Anti-Integrin Agents: These drugs block integrins, preventing immune cells from entering the gut tissue.
- Vedolizumab: Administered intravenously.
- Natalizumab: Administered intravenously, but used more often in Crohn's disease due to potential risks.
- Anti-IL-12/23 Agents: These drugs target interleukin-12 and interleukin-23, which are involved in the inflammatory process.
- Ustekinumab: Administered intravenously or subcutaneously.
5. Janus Kinase (JAK) Inhibitors
JAK inhibitors target intracellular signaling pathways involved in inflammation.
- Tofacitinib: Used for moderate to severe ulcerative colitis, administered orally. It inhibits several JAK enzymes involved in the inflammatory response.
6. Antibiotics
Antibiotics are not primary treatments but can be used to manage complications such as infections or abscesses.
- Metronidazole and Ciprofloxacin: Used for treating bacterial infections or complications associated with Crohn's disease, such as fistulas.
7. Supportive Therapies
- Probiotics: These may help maintain gut flora balance and improve symptoms in some cases, though the evidence is mixed.
- Nutritional Support: Patients may require dietary modifications or supplements to address malnutrition or deficiencies.
Treatment Strategy
- Induction Therapy: Aimed at achieving remission during acute flares.
- Maintenance Therapy: Focused on sustaining remission and preventing relapse.
Treatment decisions are tailored to the individual, considering the severity of the disease, specific symptoms, and response to previous therapies. Regular monitoring and adjustments are often necessary to manage both the disease and treatment side effects effectively.
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