Phases of treating IBD with medicine
Patients with inflammatory bowel disease (IBD) are often prescribed medicines to treat their IBD very soon after their diagnosis. Treating IBD with medicines starts early to help avoid flares and help keep the inflammation under control for as long as possible. Treating IBD with medicine happens in 2 phases: induction and maintenance.
Induction of therapy
The initial phases of treating the inflammation associated with IBD with medicine is called the induction of therapy. The medicine prescribed to you during the induction phase is meant to help you get well. In the induction phase, your healthcare provider is trying to get your inflammation under control.
The induction phase generally involves extensive monitoring through blood and stool tests. The induction phase lasts until your inflammation is reduced and you are in remission.
Maintenance of therapy
After the induction phase, you will enter the maintenance of therapy phase. During the maintenance phase, your gastroenterologist will use medicine to help keep you well. Even though you are in remission and might be feeling well, maintenance therapy is as important as induction therapy since IBD can be a complex and stubborn disease.
It is important that you do not stop taking any of your IBD medicines during the maintenance phase unless your gastroenterologist or primary healthcare provider tells you to, even if you feel well. The type of medicines you get as maintenance therapy may be the same or slightly different than what you use during a flare.
Pregnancy
Advice about medicines during pregnancy can be different for people with IBD than for people with other conditions, because the risks and benefits are not the same. For IBD, active inflammation—or a flare—can be more harmful to a pregnancy than most of the medicines used to treat it.
Some medicines need to be stopped before you try to get pregnant and cannot be taken during pregnancy. These include methotrexate, which can harm the baby, and oral small-molecule drugs, because it’s not yet known if they are safe in pregnancy.
It’s important to talk to your doctor before you start trying to get pregnant so you can talk about the risks and benefits of your medicines.
Learn more about medicines for IBD.
Types of IBD medicine
There are 5 main types of IBD medicine. They include:
5-ASAs (also called 5-aminosalicylates or sulfasalazine)
5-ASAs target the lining of the gastrointestinal (GI) tract. They are primarily used to treat mild to moderate ulcerative colitis.
5-ASAs were one of the first medicines developed to treat ulcerative colitis. They work on the lining of the GI tract to help it heal. They do this without weakening (suppressing) the entire immune system.
Depending on the type, 5-ASAs can be taken as oral pills (by mouth), suppositories, rectal foams, or liquid enemas.
Pregnancy
5-ASAs are generally safe to take during pregnancy. Having an IBD flare can be more harmful to a pregnancy than most medicines.
These medicines are generally safe to take while breastfeeding. Small amounts get into breastmilk, but they do not cause side effects in most babies. Rarely, some babies may have diarrhea, so watch your baby closely.
Talk to your doctor about the risks and benefits of these medicines.
Common medicines
The most common 5-ASAs include:
Learn more
Immunomodulators (also called immunosuppressants)
Immunomodulators target the immune system. They are used to treat Crohn’s disease and ulcerative colitis. They can be used to treat active or inactive disease.
Your immune system helps protect your body against bacteria and other harmful things. Your immune system is what usually protects you from getting sick. People with IBD can have immune systems that are overactive, or working too hard when they don’t need to be. This overactivity is what results in the inflammation in the GI tract. Immunomodulators work by slowing down or reducing the effectiveness of your body's immune system.
Because immunomodulators reduce the effectiveness of your immune system, your gastroenterologist will monitor you closely while you are taking them.
Depending on the type, immunomodulators can be taken as oral pills (by mouth), injections under the skin (subcutaneous injections), injections into the muscle, or intravenously (by I.V.).
Pregnancy
- Azathioprine: Do not stop taking azathioprine without talking to your doctor first. Having an IBD flare can be more harmful to a pregnancy than most medicines. This medicine is considered low risk and is safe to keep taking during pregnancy to manage IBD. Talk to your doctor about the risks and benefits of this medicine.
- Methotrexate: Do not take methotrexate if you are pregnant. You need to stop taking methotrexate 4 to 6 months before you get pregnant.
Common medicines
The most common immunomodulators include:
Learn more
Steroids (also called corticosteroids)
Steroids target the immune system. They are used as a short-term treatment for moderate to severe active Crohn’s disease or ulcerative colitis.
Steroids are a group of hormones that are produced by your body. They have many functions in the body, including adjusting your blood pressure, breaking down nutrients, and helping you manage stress.
Steroids that are used as IBD medicines are synthetic versions of the steroids made by your body. These steroid medicines help reduce inflammation in your body, which can let your GI tract heal.
Like immunomodulators, steroids slow down your immune system. Because of this, healthcare providers try to avoid using steroids to repeatedly treat IBD or to treat it for long periods of time.
Depending on the type, steroids can be taken as oral pills (by mouth), suppositories, rectal foams, liquid enemas, or by I.V.
Common medicines
The most common steroids include:
Learn more
Biologics (also called biotherapies, originator biologic, or biosimilars)
Biologics target a specific part of the immune system. They are used to treat Crohn’s disease and ulcerative colitis. They can be used to treat active or inactive disease.
Biologics are a type of treatment called biotherapy. The term biologic may also be used to refer to a similar type of medicine called a biosimilar. Biologics are a newer group of medicines used to treat IBD and have been in Canada since the early 2000s.
Biologics are made from proteins from living cells called antibodies. They work by targeting a specific part of your immune system. They are more precise than some other IBD medicines that target the immune system, like steroids and immunomodulators. Since biologics are made from living cells, you have to take them in a way that prevents them from being digested by the stomach. Depending on the type, biologics can be taken by I.V. or by subcutaneous injection.
Pregnancy
Biologics are generally safe during pregnancy. There is not as much information about the newer biologic medicines. Having an IBD flare can be more harmful to a pregnancy than these medicines.
Biologics are generally safe to take while breastfeeding. Small amounts of biologics get into breastmilk, but they do not cause side effects in most babies. Talk to your doctor about the risks and benefits of these medicines.
Common medicines
The most common biologics include:
Learn more
Small molecules (also called JAK inhibitors or S1p modulators)
Small molecules target a specific part of the body’s immune cells. They are primarily used to treat ulcerative colitis.
Small molecules include Janus Kinase (JAK) inhibitors and sphingosine 1-phosphate (S1p) receptor modulators.
JAK inhibitors and S1p receptor modulators work by targeting specific receptors on certain cells that belong to the body’s immune system.
Small molecules can be taken orally (by mouth).
Pregnancy
Do not take oral small molecules if you are pregnant. If you are on oral small molecules and plan to get pregnant, talk to your doctor first. There is not enough information about oral small molecules in pregnancy at this time.
Precautions when on immunosuppressive treatments
When you’re taking immunosuppressive medicines that lower your immune system, you can take precautions to reduce risks, including:
- washing your hands and practising good hygiene
- making sure your vaccines are up to date
- being safe with food, including safely cooking and storing food
- avoiding certain foods, like undercooked or raw meat or eggs, unpasteurized dairy products, and cured meats
Common medicines
The most common small molecules include:
Learn more
When you start a new medicine, pay close attention to your symptoms and if they change. Write down any new symptoms, as they could be side effects of the new medicine.
If you smoke, it is important to work towards quitting. Smoking can reduce the effectiveness of many IBD medicines, making it harder to get well. To get help with quitting smoking, visit AlbertaQuits.
